Provider Demographics
NPI:1720370828
Name:GAJJAR, ANURADHA AMAR (MD)
Entity Type:Individual
Prefix:
First Name:ANURADHA
Middle Name:AMAR
Last Name:GAJJAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 EAST 70TH STREET
Mailing Address - Street 2:3RD FLOOR, BOX 176
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:646-962-4324
Mailing Address - Fax:646-962-0246
Practice Address - Street 1:505 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:646-962-4324
Practice Address - Fax:646-962-0246
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT205529390200000X
NY288985-12080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program