Individual
DR. RAJIV DATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 S CENTRAL AVE, VALLEY STREAM, NY 11580-5443
(516) 632-3300
(516) 632-3355
Mailing address
1 HEALTHY WAY, ATTN: PHYSICIAN BILLING, OCEANSIDE, NY 11572-1551
(516) 255-1616
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
201327
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01621461
—
NY
Enumeration date
09/23/2005
Last updated
05/13/2013
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