Healthcare Provider Details

I. General information

NPI: 1477504363
Provider Name (Legal Business Name): ANJAN RAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 7TH AVE FL 1
BROOKLYN NY
11215-5513
US

IV. Provider business mailing address

166 78TH ST
BROOKLYN NY
11209-2914
US

V. Phone/Fax

Practice location:
  • Phone: 718-832-1964
  • Fax: 718-832-0526
Mailing address:
  • Phone: 718-680-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number168069
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number168069
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number168069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: