Basic Information
Provider Information
NPI: 1447353792
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHARMA
FirstName: RAKESH
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 59 KOCH AVE
Address2:  
City: MORRIS PLAINS
State: NJ
PostalCode: 079504400
CountryCode: US
TelephoneNumber: 9735381800
FaxNumber:  
Practice Location
Address1: 59 KOCH AVE
Address2:  
City: MORRIS PLAINS
State: NJ
PostalCode: 079504400
CountryCode: US
TelephoneNumber: 9735381800
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/05/2006
LastUpdateDate: 10/06/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X241196NYN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X25MA08492000NJY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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