Provider Demographics
NPI:1477732048
Name:RAJENDRA PRADHAN, M. D. P.C.
Entity Type:Organization
Organization Name:RAJENDRA PRADHAN, M. D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:PRADHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-982-0600
Mailing Address - Street 1:372 CENTRAL PARK WEST
Mailing Address - Street 2:12G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8240
Mailing Address - Country:US
Mailing Address - Phone:212-982-0600
Mailing Address - Fax:
Practice Address - Street 1:247 3RD AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7457
Practice Address - Country:US
Practice Address - Phone:212-982-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114439207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00209494Medicaid
W4L281Medicare Oscar/Certification