Healthcare Provider Details

I. General information

NPI: 1588854244
Provider Name (Legal Business Name): RAJ SAHULEE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAJ SAHU

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4321
  • Fax:
Mailing address:
  • Phone: 718-920-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60245395
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number25MB09488200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberOS016163
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number245395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: