Healthcare Provider Details

I. General information

NPI: 1235224858
Provider Name (Legal Business Name): RAJAT S SANYAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 ASHFORD AVENUE
DOBBS FERRY NY
10522-1812
US

IV. Provider business mailing address

88 ASHFORD AVENUE SUITE 101
DOBBS FERRY NY
10522-1812
US

V. Phone/Fax

Practice location:
  • Phone: 914-478-0641
  • Fax: 914-478-3479
Mailing address:
  • Phone: 914-478-0641
  • Fax: 914-478-3479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number203483
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number203483
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01902721
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: