Provider Demographics
NPI:1083710628
Name:THIAGARAJAH, YOGASAUNDARI (MD)
Entity Type:Individual
Prefix:DR
First Name:YOGASAUNDARI
Middle Name:
Last Name:THIAGARAJAH
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 1:506 MALCOLM X BLVD
Mailing Address - Street 2:WP-522
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1802
Mailing Address - Country:US
Mailing Address - Phone:212-939-2740
Mailing Address - Fax:212-939-2759
Practice Address - Street 1:506 LENOX AVE
Practice Address - Street 2:RBB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-1431
Practice Address - Fax:212-939-1432
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB10145Medicare UPIN
NY17D721Medicare ID - Type Unspecified