MEDICARE: RAJENDRA ACHAIBAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	06070700	NJ

General Provider Information

NPI Number	:	1649225939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJENDRA ACHAIBAR

Provider Business Mailing Address
First Line	:	105 N WATER ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-6060
Country	:	US
Telephone Number	:	414-359-5745
Fax Number	:	414-359-5703

Provider Business Practice Location Address
First Line	:	330 RATZER RD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7702
Country	:	US
Telephone Number	:	973-696-5770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	01/16/2013

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