Provider Demographics
NPI:1487735155
Name:GULATI, RAJAN (MD)
Entity type:Individual
Prefix:
First Name:RAJAN
Middle Name:
Last Name:GULATI
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 1:45 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-1403
Mailing Address - Country:US
Mailing Address - Phone:585-968-1628
Mailing Address - Fax:585-968-0019
Practice Address - Street 1:45 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1403
Practice Address - Country:US
Practice Address - Phone:585-968-1628
Practice Address - Fax:585-968-0019
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141658207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00732825Medicaid
NY00732825Medicaid
B71712Medicare UPIN