Provider Demographics
NPI:1902891831
Name:MURALI, RAJ (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:
Last Name:MURALI
Suffix:
Gender:M
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:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-0098
Mailing Address - Country:US
Mailing Address - Phone:914-594-3510
Mailing Address - Fax:914-594-4002
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 2800
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-345-8111
Practice Address - Fax:914-345-3182
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126605-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01075227Medicaid
NY22A911Medicare PIN
NY22A91X0531Medicare PIN
NY01075227Medicaid