Provider Demographics
NPI:1962410159
Name:RAINA, SANTOSH (MD)
Entity type:Individual
Prefix:
First Name:SANTOSH
Middle Name:
Last Name:RAINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 GALLOPING HILL RD
Practice Address - Street 2:UNION HOSPITAL
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7951
Practice Address - Country:US
Practice Address - Phone:908-851-7143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03728100207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8465401Medicaid
NJ002649B2KMedicare Oscar/Certification
NJF04918Medicare UPIN