Provider Demographics
NPI:1063536662
Name:BAJAJ, RANDHIR K (MD)
Entity type:Individual
Prefix:DR
First Name:RANDHIR
Middle Name:K
Last Name:BAJAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6629 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2540
Mailing Address - Country:US
Mailing Address - Phone:718-424-4500
Mailing Address - Fax:718-424-0132
Practice Address - Street 1:6629 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2540
Practice Address - Country:US
Practice Address - Phone:718-424-4500
Practice Address - Fax:718-424-0132
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157267207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00954967Medicaid
NY12680AMedicare PIN
NY00954967Medicaid