Basic Information
| Provider Information | |||||||||
| NPI: | 1659626026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAO | ||||||||
| FirstName: | EHSEN | ||||||||
| MiddleName: | ZAWWAR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 CLIFTON AVE | ||||||||
| Address2: | APT # C1112 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071041880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035897068 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 BERGEN ST | ||||||||
| Address2: | SUITE E-401 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739725682 | ||||||||
| FaxNumber: | 9739726591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2012 | ||||||||
| LastUpdateDate: | 07/20/2012 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.