1104447861 NPI number — MR. DON CHERIAN RAJAN MD

Table of content: SHERRY GIBBENS (NPI 1235770199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104447861 NPI number — MR. DON CHERIAN RAJAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAJAN
Provider First Name:
DON
Provider Middle Name:
CHERIAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1104447861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/11/2022
NPI Reactivation Date:
02/22/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8053 LANGDALE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWHYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-787-5125
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5423 S MCCOLL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURGH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-442-6412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD61372214 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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