Basic Information
| Provider Information | |||||||||
| NPI: | 1821001272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALEM | ||||||||
| FirstName: | RAJA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 PRINCETON PIKE | ||||||||
| Address2: | BLDG 5 SUITE 208 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098157829 | ||||||||
| FaxNumber: | 6098157894 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 FULD ST | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086385247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093962600 | ||||||||
| FaxNumber: | 6093963600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 11/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA06188700 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 6625606 | 05 | NJ | MEDICAID |