1275855991 NPI number — MR. RAJ PANDE R.PH

Table of content: MR. RAJ PANDE R.PH (NPI 1275855991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275855991 NPI number — MR. RAJ PANDE R.PH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANDE
Provider First Name:
RAJ
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.PH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275855991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
384 MEADOW DR
Provider Second Line Business Mailing Address:
APT #4
Provider Business Mailing Address City Name:
NORTH TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14120-2821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-797-6583
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1066 PAYNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14120-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-694-0323
Provider Business Practice Location Address Fax Number:
716-693-1506
Provider Enumeration Date:
02/22/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  053280-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 29711 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)