Provider Demographics
NPI:1609950617
Name:ACHARYA, NIRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:
Last Name:ACHARYA
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 1:19616 HILLSIDE AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2125
Mailing Address - Country:US
Mailing Address - Phone:718-301-5894
Mailing Address - Fax:
Practice Address - Street 1:19616 HILLSIDE AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2125
Practice Address - Country:US
Practice Address - Phone:718-301-5894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196301207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01496102Medicaid
NY40J861Medicare PIN
F89815Medicare UPIN
NY04242Medicare PIN