Healthcare Provider Details

I. General information

NPI: 1609995455
Provider Name (Legal Business Name): RAJAN GULATI PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WEST MAIN STREET
CUBA NY
14727-1403
US

IV. Provider business mailing address

45 WEST MAIN STREET
CUBA NY
14727-1403
US

V. Phone/Fax

Practice location:
  • Phone: 585-968-1628
  • Fax: 585-968-0019
Mailing address:
  • Phone: 585-968-1628
  • Fax: 585-968-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1416581
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number1416581
License Number StateNY

VIII. Authorized Official

Name: DR. RAJAN GULATI
Title or Position: OWNER
Credential: MD
Phone: 585-968-1628