Provider Demographics
NPI:1174627277
Name:SARWAL, RAJU (MD)
Entity Type:Individual
Prefix:
First Name:RAJU
Middle Name:
Last Name:SARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:11547-0538
Mailing Address - Country:US
Mailing Address - Phone:631-231-4455
Mailing Address - Fax:631-257-5097
Practice Address - Street 1:601 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4309
Practice Address - Country:US
Practice Address - Phone:631-231-4455
Practice Address - Fax:631-257-5097
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228351207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02492253Medicaid
NY228351SOtherHEALTHCARE PARTNERS
NY9040521OtherCIGNA
NYP2947060OtherOXFORD
NY4277432OtherAETNA PPO
NY438B31OtherBC/ BS BRENTWOOD
NY00000076253OtherGHI HMO
NY112355523OtherMAGNACARE
NY112355523OtherMUTLTIPLAN
NY3C6845OtherHEALTHNET
NY0498469OtherGHI PPO
NY131077POtherHIP
NY2300056OtherAETNA HMO
NY02492253Medicaid