Basic Information
| Provider Information | |||||||||
| NPI: | 1982263224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAJWANA | ||||||||
| FirstName: | YASIR | ||||||||
| MiddleName: | RAFIQUE | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 355 GRAND STREET | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019152431 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | JERSEY CITY MEDICAL CENTER | ||||||||
| Address2: | 355 - GRAND STREET | ||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019152431 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2019 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/17/2020 | ||||||||
| NPIReactivationDate: | 12/03/2020 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.