Healthcare Provider Details

I. General information

NPI: 1780262261
Provider Name (Legal Business Name): JOSH RAJ SEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

750 E ADAMS ST CWB ROOM #241
SYRACUSE NY
13210-2342
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4636
  • Fax: 315-464-7282
Mailing address:
  • Phone: 315-464-4636
  • Fax: 315-464-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number344285
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: