Provider Demographics
NPI:1497815047
Name:NANDAKUMAR, RAJINI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJINI
Middle Name:
Last Name:NANDAKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6909
Mailing Address - Country:US
Mailing Address - Phone:845-639-0576
Mailing Address - Fax:845-639-0576
Practice Address - Street 1:545 E 142ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-2110
Practice Address - Country:US
Practice Address - Phone:718-579-5000
Practice Address - Fax:718-579-4024
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190203208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics