Provider Demographics
NPI:1861625279
Name:SOOD, RAHUL (DO)
Entity type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:SOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4222
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-8222
Mailing Address - Country:US
Mailing Address - Phone:862-238-8250
Mailing Address - Fax:862-238-8255
Practice Address - Street 1:50 MOUNT PROSPECT AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1900
Practice Address - Country:US
Practice Address - Phone:862-238-8250
Practice Address - Fax:862-238-8255
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08610000208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB08610000OtherLICENSE
NJ191251Medicare PIN