Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 40QA00197100 | NJ |
Y | 213ES0000X | Sports Medicine | 40QA00197100 | NJ |
NPI | 1275603391 |
---|---|
Provider Name | Rajendra V Ram |
First Address | Wayne, NJ 07470 |
Second Address | Wayne, NJ 07470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |