Healthcare Provider Details

I. General information

NPI: 1124074091
Provider Name (Legal Business Name): RAJESWARI KANTHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S BLACK HORSE PIKE
WILLIAMSTOWN NJ
08094-1900
US

IV. Provider business mailing address

925 S BLACK HORSE PIKE
WILLIAMSTOWN NJ
08094-1900
US

V. Phone/Fax

Practice location:
  • Phone: 856-629-9000
  • Fax: 856-629-6440
Mailing address:
  • Phone: 856-629-9000
  • Fax: 856-629-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA05934000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: