Healthcare Provider Details

I. General information

NPI: 1497815047
Provider Name (Legal Business Name): RAJINI NANDAKUMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E 142ND ST
BRONX NY
10454-2110
US

IV. Provider business mailing address

140 RIDGE RD
NEW CITY NY
10956-6909
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5000
  • Fax: 718-579-4024
Mailing address:
  • Phone: 845-639-0576
  • Fax: 845-639-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number190203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: