Healthcare Provider Details

I. General information

NPI: 1831373752
Provider Name (Legal Business Name): KANISHKA RAJPUT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST # ST3
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST. TMP3
NEW HAVEN CT
06510
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2802
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-785-2802
  • Fax: 203-785-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number051731
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number51731
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number051731
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: