Provider Demographics
NPI:1679961940
Name:MOHAMMED, RAJI HUSSAIN (MD)
Entity type:Individual
Prefix:
First Name:RAJI
Middle Name:HUSSAIN
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4264
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-0264
Mailing Address - Country:US
Mailing Address - Phone:845-565-5446
Mailing Address - Fax:845-562-7995
Practice Address - Street 1:1 WASHINGTON AVE
Practice Address - Street 2:APT 15-2B
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4341
Practice Address - Country:US
Practice Address - Phone:917-575-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265240207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology