Provider Demographics
NPI:1467783605
Name:NAGARAJAN, SAYEEN BALUSAMY (RPH)
Entity Type:Individual
Prefix:
First Name:SAYEEN
Middle Name:BALUSAMY
Last Name:NAGARAJAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13850 84TH DR
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1840
Mailing Address - Country:US
Mailing Address - Phone:718-739-9099
Mailing Address - Fax:718-739-6824
Practice Address - Street 1:13850 84TH DR
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1840
Practice Address - Country:US
Practice Address - Phone:718-739-9099
Practice Address - Fax:718-739-6824
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02843272Medicaid
NY33632OtherPHARMACIST