Provider Demographics
NPI:1992894943
Name:PRADHAN, RAJENDRA (MD PC)
Entity type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 CENTRAL PARK WEST
Mailing Address - Street 2:APARTMENT 12GH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8209
Mailing Address - Country:US
Mailing Address - Phone:347-875-0139
Mailing Address - Fax:
Practice Address - Street 1:372 CENTRAL PARK WEST
Practice Address - Street 2:APARTMENT 12G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8209
Practice Address - Country:US
Practice Address - Phone:212-677-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114439207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0020949Medicaid
NYB78422Medicare UPIN
NY0020949Medicaid