Provider Demographics
NPI:1952583205
Name:ANANDARAJA, NATASHA ANUSHRI (MD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:ANUSHRI
Last Name:ANANDARAJA
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 1:346 BROADWAY
Mailing Address - Street 2:BOX 72 RM 831 NYCDOHMH DIVISION OF DISEASE CONTROL THIR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3990
Mailing Address - Country:US
Mailing Address - Phone:212-442-8468
Mailing Address - Fax:212-442-8452
Practice Address - Street 1:3433 JUNCTION BLVD
Practice Address - Street 2:2ND FL
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3828
Practice Address - Country:US
Practice Address - Phone:718-476-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237825208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics