Healthcare Provider Details

I. General information

NPI: 1457989808
Provider Name (Legal Business Name): ABHINAV RAJ SAXENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD RM 176
STONY BROOK NY
11794-3017
US

IV. Provider business mailing address

110 IRVING ST NW DEPT OF
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-7515
  • Fax:
Mailing address:
  • Phone: 202-877-8278
  • Fax: 202-877-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD210012324
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: