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General NPI Number Information
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NPI Number | 1548262546
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Entity Type | Organization
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Legal Business Name | NORTHEAST SURGICAL GROUP, PLLC
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 19 BRADHURST AVE STE. 0100
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City | HAWTHORNE
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State | NY
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Zip | 10532-2140
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Country | US
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Telephone | 914-493-7378
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Fax | 914-594-4949
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Provider Business Mailing Address
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Address Line | 551 MUNGER PAVILION
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City | VALHALLA
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State | NY
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Zip | 10595
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Country | US
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Telephone | 914-493-7378
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Fax | 914-594-4949
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Authorized Official
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Title or Position | MD/OWNER
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Name | HEENA RAJDEO
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Credential | MD
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Telephone | 914-493-7378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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