Healthcare Provider Details

I. General information

NPI: 1871747097
Provider Name (Legal Business Name): RAJKUMAR JEGANATHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 LAFAYETTE AVE STE 200
SUFFERN NY
10901-4837
US

IV. Provider business mailing address

20 GRAND ST FL 3
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 845-369-8800
  • Fax: 845-357-0086
Mailing address:
  • Phone: 716-372-0141
  • Fax: 716-376-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number276238
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number276238
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: