Provider Demographics
NPI:1649229188
Name:MUKHERJI, RAJAT K (MD)
Entity Type:Individual
Prefix:
First Name:RAJAT
Middle Name:K
Last Name:MUKHERJI
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 1:120 BOERUM PL
Mailing Address - Street 2:APT 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6279
Mailing Address - Country:US
Mailing Address - Phone:718-855-3582
Mailing Address - Fax:
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1809
Practice Address - Country:US
Practice Address - Phone:718-604-5401
Practice Address - Fax:718-604-5574
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY140692207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00758301Medicaid
NYB20222Medicare UPIN
NY00758301Medicaid