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General NPI Number Information
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NPI Number | 1033167986
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Entity Type | Individual
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Provider Name | RAED A JITAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 15 MCCAMPBELL RD
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City | HOLMDEL
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State | NJ
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Zip | 07733-2291
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Country | US
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Telephone | 732-946-0995
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Fax | 732-946-0995
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Provider Business Mailing Address
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Address Line | 15 MCCAMPBELL RD
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City | HOLMDEL
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State | NJ
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Zip | 07733-2291
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Country | US
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Telephone | 732-946-0995
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Fax | 732-946-0995
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA07843100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 17922
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 31939
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 84811
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 20531
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License Number State | SC
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Taxonomy #6
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 23877
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License Number State | AL
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Taxonomy #7
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 29166
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License Number State | IA
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