Provider Demographics
NPI: | 1477504363 |
---|---|
Name: | RAU, ANJAN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ANJAN |
Middle Name: | |
Last Name: | RAU |
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: | 166 78TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11209-2914 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-680-2198 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 459 7TH AVE FL 1 |
Practice Address - Street 2: | |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11215-5513 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-832-1964 |
Practice Address - Fax: | 718-832-0526 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-05-15 |
Last Update Date: | 2022-03-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 168069 | 174400000X, 208600000X, 2086S0129X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No | 174400000X | Other Service Providers | Specialist | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 01816875 | Medicaid | |
NY | 05530G | Medicare PIN | |
E44733 | Medicare UPIN | ||
NY | 01816875 | Medicaid |