Provider Demographics
NPI:1619934460
Name:KAKANI, RAJESH S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:S
Last Name:KAKANI
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 1:877 STEWART AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4803
Mailing Address - Country:US
Mailing Address - Phone:516-222-1105
Mailing Address - Fax:516-222-1161
Practice Address - Street 1:877 STEWART AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4803
Practice Address - Country:US
Practice Address - Phone:516-222-1105
Practice Address - Fax:516-222-1161
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208436207Y00000X
NJMA68818207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01928418Medicaid
NYG87270Medicare UPIN
NY05936GMedicare ID - Type UnspecifiedGHI MEDICARE
NY07Z331Medicare ID - Type UnspecifiedEMPIRE MEDICARE SERVICES