Provider Demographics
NPI:1124647961
Name:SOOMAR, RAEESA ASHFAQ
Entity type:Individual
Prefix:
First Name:RAEESA
Middle Name:ASHFAQ
Last Name:SOOMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2542
Mailing Address - Country:US
Mailing Address - Phone:732-381-3642
Mailing Address - Fax:732-396-4463
Practice Address - Street 1:546 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2542
Practice Address - Country:US
Practice Address - Phone:732-381-3642
Practice Address - Fax:732-396-4463
Is Sole Proprietor?:No
Enumeration Date:2020-04-12
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12780100207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology