Healthcare Provider Details

I. General information

NPI: 1700263597
Provider Name (Legal Business Name): GAGANDEEP RAJU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GAGAN RAJU MD

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TURNPIKE DEPARTMENT OF MEDICINE
EAST MEADOW NY
11554
US

IV. Provider business mailing address

2201 HEMPSTEAD TURNPIKE DEPARTMENT OF MEDICINE
EAST MEADOW NY
11554
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-1653
  • Fax: 212-289-6393
Mailing address:
  • Phone: 224-628-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number296694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: