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General NPI Number Information
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NPI Number | 1184888091
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Entity Type | Organization
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Legal Business Name | RAJASHREE KANTHA, M.D., P.A.
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 1124 E RIDGEWOOD AVE STE 102
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3943
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Country | US
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Telephone | 201-445-7744
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Fax | 201-445-7767
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Provider Business Mailing Address
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Address Line | 1124 E RIDGEWOOD AVE STE 102
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3943
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Country | US
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Telephone | 201-445-7744
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Fax | 201-445-7767
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. RAJASHREE KANTHA
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Credential | M.D.
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Telephone | 201-445-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA07366300
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License Number State | NJ
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