=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710969167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAJBIR SINGH CHOPRA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2005
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 290 CENTRAL AVE STE 205
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11559-8507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-881-7340
-----------------------------------------------------
Fax | 516-881-7341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 290 CENTRAL AVE STE 205
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11559-8507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-881-7340
-----------------------------------------------------
Fax | 516-881-7341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 160886
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------