Provider Demographics
NPI:1255512703
Name:RAJ, ANU (PHD)
Entity type:Individual
Prefix:
First Name:ANU
Middle Name:
Last Name:RAJ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 JERICHO TPKE STE 213
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4501
Mailing Address - Country:US
Mailing Address - Phone:917-670-8367
Mailing Address - Fax:
Practice Address - Street 1:175 JERICHO TPKE STE 213
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4501
Practice Address - Country:US
Practice Address - Phone:917-670-8367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015784-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02933686Medicaid
NYV3R721Medicare PIN
NY0476DVMedicare PIN
NY02933686Medicaid
NYV3R72V0441Medicare PIN
NYV3R72V5761Medicare PIN