Provider Demographics
NPI:1427066596
Name:MONGIA, RUPA SUDHIR (MD)
Entity type:Individual
Prefix:DR
First Name:RUPA
Middle Name:SUDHIR
Last Name:MONGIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RUPA
Other - Middle Name:MOHANLAL
Other - Last Name:RAIZADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3250 ROUTE 27
Mailing Address - Street 2:SUITE 102/103
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1536
Mailing Address - Country:US
Mailing Address - Phone:732-398-9100
Mailing Address - Fax:732-398-9105
Practice Address - Street 1:3250 ROUTE 27
Practice Address - Street 2:SUITE 102/103
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1536
Practice Address - Country:US
Practice Address - Phone:732-398-9100
Practice Address - Fax:732-398-9105
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO62435207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ161627691OtherBLUECROSS BLUESHEILD
NJ2958634OtherAETNA
NJ7475209Medicaid
NJ161627691OtherBLUECROSS BLUESHEILD
NJ7475209Medicaid