Healthcare Provider Details

I. General information

NPI: 1053491548
Provider Name (Legal Business Name): LAKSHMI N RAJDEV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEILER - DEPT. OF ONCOLOGY 1695 EASTCHESTER ROAD
BRONX NY
10461
US

IV. Provider business mailing address

400 E 77TH ST APT 16A
NEW YORK NY
10075-2303
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8505
  • Fax:
Mailing address:
  • Phone: 718-405-8505
  • Fax: 718-405-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number195576
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: