Healthcare Provider Details

I. General information

NPI: 1346344710
Provider Name (Legal Business Name): RAJESH SAVARGAONKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1556 STRAIGHT PATH MARTIN LUTHER KING JR HEALTH CENTER
WYANDANCH NY
11798
US

IV. Provider business mailing address

1556 STRAIGHT PATH
WYANDANCH NY
11798
US

V. Phone/Fax

Practice location:
  • Phone: 631-854-1700
  • Fax: 631-854-1789
Mailing address:
  • Phone: 631-854-1700
  • Fax: 631-854-1789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number213200
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01793264
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: