Healthcare Provider Details

I. General information

NPI: 1942475603
Provider Name (Legal Business Name): ANDREW B. RAJAPAKSE, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 GREEN ST
WOODBRIDGE NJ
07095-2910
US

IV. Provider business mailing address

107 GREEN ST
WOODBRIDGE NJ
07095-2910
US

V. Phone/Fax

Practice location:
  • Phone: 732-634-8483
  • Fax: 732-634-8626
Mailing address:
  • Phone: 732-634-8483
  • Fax: 732-634-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA028742
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08277300NJ
License Number StateNJ

VIII. Authorized Official

Name: DR. ANDREW B. RAJAPAKSE
Title or Position: CEO
Credential: MD
Phone: 732-634-8483