Healthcare Provider Details

I. General information

NPI: 1457381592
Provider Name (Legal Business Name): RAJANI SURAPANENI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST AVE 16 STREET
NEW YORK NY
10003
US

IV. Provider business mailing address

1780 BROADWAY
NEW YORK NY
10019-1414
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8880
  • Fax: 212-844-6807
Mailing address:
  • Phone: 212-590-2930
  • Fax: 212-590-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number125115
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number125115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: