Provider Demographics
NPI:1760478978
Name:VOHRA, RAJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJEEV
Middle Name:
Last Name:VOHRA
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:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-0489
Mailing Address - Country:US
Mailing Address - Phone:516-551-1968
Mailing Address - Fax:516-374-8675
Practice Address - Street 1:1420 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1352
Practice Address - Country:US
Practice Address - Phone:516-374-8670
Practice Address - Fax:516-374-8675
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178004208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01618024Medicaid
NY01618024Medicaid
NY87L871Medicare ID - Type Unspecified