Organization
MEDCOM NEUROLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILYAS A RAJPUT MD (PRESIDENT)
(609) 646-4064
Entity
Organization
Contact information
Practice address
310 CHRIS GAUPP DR, SUITE 101, GALLOWAY, NJ 08205-4461
(609) 909-5355
(609) 909-5357
Mailing address
258 N NEW RD, PLEASANTVILLE, NJ 08232-2170
(609) 646-4064
(609) 272-8526
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0088072
—
NJ
Enumeration date
07/07/2006
Last updated
01/07/2008
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