Individual
RAJENDRA KUMAR MODI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55-44 METROPOLITAN AVENUE, RIDGEWOOD, NY 11385
(718) 456-2020
(718) 821-5342
Mailing address
55-44 METROPOLITAN AVENUE, RIDGEWOOD, NY 11385
(718) 456-2020
(718) 821-5342
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
154743
NY
207W00000X
Ophthalmology Physician
Primary
154743
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00773280
—
NY
05
—
0773280
—
NY
01
—
74937
AETNA USHC
NY
01
—
DS376
OXFORD
NY
Enumeration date
10/14/2005
Last updated
01/03/2011
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