MEDICARE: RAJ MEDICAL DIAGNOSTICS PC

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	207R00000X	Internal Medicine Physician	55603	CT

General Provider Information

NPI Number	:	1922547769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAJ MEDICAL DIAGNOSTICS PC

Provider Business Mailing Address
First Line	:	887 RUTLAND RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-1911
Country	:	US
Telephone Number	:	917-940-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	3180 MAIN ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-4237
Country	:	US
Telephone Number	:	917-940-0360
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATION SECRETARY
Name	:	RACQUEL PETERS
Credential	:
Telephone Number	:	917-940-0360

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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