Provider Demographics
NPI:1649250812
Name:GANGULY, RAKHI (MD)
Entity type:Individual
Prefix:
First Name:RAKHI
Middle Name:
Last Name:GANGULY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CHICKEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2103
Mailing Address - Country:US
Mailing Address - Phone:718-379-1800
Mailing Address - Fax:718-320-0749
Practice Address - Street 1:140 BENCHLEY PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3502
Practice Address - Country:US
Practice Address - Phone:718-379-1800
Practice Address - Fax:718-320-0749
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147280207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY147280OtherHEALTH INSURANCE PLAN
NY2C3366OtherHEALTHNET
NY20351OtherAETNA
NY00803OtherEMPIRE BLUE CROS AND BLUE
NYDP043OtherOXFORD
NY0036636OtherGROUP HEALTH INCORPORATED
NY00738376Medicaid
NY13162Other1199 LOCAL BENEFIT FUND
NY00803OtherEMPIRE BLUE CROS AND BLUE
NYDP043OtherOXFORD