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
StateLicense IDTaxonomies
NY168069174400000X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01816875Medicaid
NY05530GMedicare PIN
E44733Medicare UPIN
NY01816875Medicaid