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General NPI Number Information
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NPI Number | 1730295502
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Entity Type | Individual
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Provider Name | RAKSHA J GAJARAWALA MD
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 1096 BROAD ST
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City | NEWARK
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State | NJ
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Zip | 07114-2004
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Country | US
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Telephone | 973-242-0191
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Fax | 973-242-0593
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Provider Business Mailing Address
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Address Line | 4 PELLINGTON CT
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City | PINE BROOK
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State | NJ
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Zip | 07058-9648
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Country | US
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Telephone | 973-242-0191
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Fax | 973-242-0593
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32176
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 32176
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License Number State | NJ
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