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General NPI Number Information
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NPI Number | 1942475603
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Entity Type | Organization
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Legal Business Name | ANDREW B. RAJAPAKSE, MD PA
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 107 GREEN ST
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-2910
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Country | US
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Telephone | 732-634-8483
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Fax | 732-634-8626
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Provider Business Mailing Address
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Address Line | 107 GREEN ST
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-2910
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Country | US
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Telephone | 732-634-8483
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Fax | 732-634-8626
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Authorized Official
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Title or Position | CEO
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Name | DR. ANDREW B. RAJAPAKSE
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Credential | MD
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Telephone | 732-634-8483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA08277300NJ
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MA028742
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License Number State | NJ
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