Provider Demographics
NPI:1679520381
Name:KADIYALA, RAJENDRA KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:KUMAR
Last Name:KADIYALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:622 W 168TH ST
Mailing Address - Street 2:PH 11-1130
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-5974
Mailing Address - Fax:212-305-6193
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-6193
Practice Address - Fax:212-305-6193
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY270923207X00000X, 207XS0106X, 2086S0105X, 207X00000X, 207XS0106X
FLME89940207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1679520381OtherNPI NUMBER
FL270134100Medicaid
G26417Medicare UPIN
FL270134100Medicaid