Provider Demographics
NPI:1942210372
Name:NAIDOO, RAJENDRAN (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDRAN
Middle Name:
Last Name:NAIDOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJEN
Other - Middle Name:
Other - Last Name:NAIDOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12989 SOUTHERN BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9211
Mailing Address - Country:US
Mailing Address - Phone:561-793-6633
Mailing Address - Fax:561-793-6688
Practice Address - Street 1:12989 SOUTHERN BLVD
Practice Address - Street 2:STE 202, BLDG THREE
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9211
Practice Address - Country:US
Practice Address - Phone:561-793-6633
Practice Address - Fax:561-798-6688
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100199207X00000X, 207XS0114X, 207XX0801X
NY224540-2207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02349902Medicaid
NY467F41Medicare ID - Type Unspecified
NY02349902Medicaid