Provider Demographics
NPI:1467491423
Name:BHAYANI, RAJENDRA DAMODAR (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:DAMODAR
Last Name:BHAYANI
Suffix:
Gender:M
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:PO BOX 230207
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-0207
Mailing Address - Country:US
Mailing Address - Phone:718-645-2555
Mailing Address - Fax:
Practice Address - Street 1:1783 W 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1321
Practice Address - Country:US
Practice Address - Phone:718-645-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226427207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02608428Medicaid
NYH93821Medicare UPIN
NY02608428Medicaid