Provider Demographics
NPI:1043353642
Name:MADANKUMAR, RAJEEVI (MD)
Entity Type:Individual
Prefix:
First Name:RAJEEVI
Middle Name:
Last Name:MADANKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270-5, 76TH AVE
Mailing Address - Street 2:SUITE T 457 A
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1704
Mailing Address - Country:US
Mailing Address - Phone:718-470-5468
Mailing Address - Fax:
Practice Address - Street 1:270-5, 76TH AVE
Practice Address - Street 2:SUITE T 457 A
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1704
Practice Address - Country:US
Practice Address - Phone:718-470-5468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231469207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02672737Medicaid
NY0105VTMedicare ID - Type Unspecified
NY02672737Medicaid