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1164041083 NPI number — RAJATH RAO MD

NPI Number: 1164041083
Health Care Provider/Practitioner: RAJATH RAO MD

Information about “1164041083” NPI (RAJATH RAO MD) exists in 1164041083 in HTML format HTML  |  1164041083 in plain Text format TXT  |  1164041083 in PDF (Portable Document Format) PDF  |  1164041083 in an XML format XML  formats.

NPI Number : 1164041083 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164041083",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RAO",
    "FirstName": "RAJATH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "RAO",
    "OtherFirstName": "RAJATH",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "54 WATKINS AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STATEN ISLAND",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10312-1523",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "201-668-1540",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "475 SEAVIEW AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STATEN ISLAND",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10305-3436",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "718-226-8855",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/10/2020",
    "LastUpdateDate": "10/09/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2085R0202X",
        "TaxonomyName": "Diagnostic Radiology Physician",
        "LicenseNumber": "340350",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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