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NPI Code Detail

MEDICARE: DR. RAJIV DATTA M.D.

MEDICARE:  DR. RAJIV  DATTA  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086X0206XSurgical Oncology Physician201327NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457347601
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAJIV DATTA M.D.
Provider Business Mailing Address
First Line : 1 HEALTHY WAY
Second Line : ATTN: PHYSICIAN BILLING
City : OCEANSIDE
State : NY
Zip : 11572-1551
Country : US
Telephone Number : 516-255-1616
Fax Number :
Provider Business Practice Location Address
First Line : 1 S CENTRAL AVE
Second Line :
City : VALLEY STREAM
State : NY
Zip : 11580-5443
Country : US
Telephone Number : 516-632-3300
Fax Number : 516-632-3355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 05/13/2013

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