Provider Demographics
NPI:1386622140
Name:RAJKOWSKI, DAVID L (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:RAJKOWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SICOMAC RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2971
Mailing Address - Country:US
Mailing Address - Phone:973-427-7801
Mailing Address - Fax:973-427-7969
Practice Address - Street 1:33 SICOMAC RD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2971
Practice Address - Country:US
Practice Address - Phone:973-427-7801
Practice Address - Fax:973-427-7969
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA5324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ631657NXTMedicare ID - Type Unspecified
NJU55002Medicare UPIN