1801994868 NPI number — RANJANA MATHUR M.D.

Table of content: RANJANA MATHUR M.D. (NPI 1801994868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801994868 NPI number — RANJANA MATHUR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHUR
Provider First Name:
RANJANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1801994868
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 WENTWORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBERTSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11507-1727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-248-5245
Provider Business Mailing Address Fax Number:
516-248-7195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 ROANOKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERHEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11901-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-548-6146
Provider Business Practice Location Address Fax Number:
631-548-6150
Provider Enumeration Date:
09/20/2006

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: 207ZP0102X , with the licence number:  170151 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00351347 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0132501 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".