Provider Demographics
NPI:1083905962
Name:RAJENDRA MARK RAMPERSAUD MD PLLC
Entity Type:Organization
Organization Name:RAJENDRA MARK RAMPERSAUD MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMPERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-684-6393
Mailing Address - Street 1:1250 WATERS PL STE 505
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2732
Mailing Address - Country:US
Mailing Address - Phone:718-684-6393
Mailing Address - Fax:718-684-6395
Practice Address - Street 1:1250 WATERS PL STE 505
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2732
Practice Address - Country:US
Practice Address - Phone:718-684-6393
Practice Address - Fax:718-684-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234613-1173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02635885Medicaid