=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902580681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RB HEART AND VASCULAR CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2023
-----------------------------------------------------
Last Update Date | 07/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 79 ROUTE 59
-----------------------------------------------------
City | SUFFERN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10901-4913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-530-0070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 76 FAIRWAYS DR
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-2666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-530-0070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RISHI BAJAJ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 781-530-0070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------