Provider Demographics
NPI:1760448914
Name:RAJENDRAN, RENGASAMY (MD)
Entity Type:Individual
Prefix:
First Name:RENGASAMY
Middle Name:
Last Name:RAJENDRAN
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 1:2333 ELMWOOD AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-0710
Mailing Address - Country:US
Mailing Address - Phone:716-874-1098
Mailing Address - Fax:716-874-9616
Practice Address - Street 1:2950 ELMWOOD AVE
Practice Address - Street 2:KENMORE MERCY HOSPITAL
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217
Practice Address - Country:US
Practice Address - Phone:716-447-6100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1941031207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011177002OtherUNIVERA
2008061OtherINDEPENDENT HEALTH
NY000523954001OtherBLUE CROSS
NY01843223Medicaid
F70221Medicare UPIN
2008061OtherINDEPENDENT HEALTH