Provider Demographics
NPI:1902593312
Name:TRIVEDI, FORUM RAJESH (MD)
Entity Type:Individual
Prefix:MS
First Name:FORUM
Middle Name:RAJESH
Last Name:TRIVEDI
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 1:125 PATERSON ST. ROOM MEB 587
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901
Mailing Address - Country:US
Mailing Address - Phone:732-235-3382
Mailing Address - Fax:732-235-3384
Practice Address - Street 1:597 PARK AVENUE SUITE A
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-294-4009
Practice Address - Fax:732-409-2621
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program