Active NPI
Kenan Rodwan Rajjoub, MD
- Student in an Organized Health Care Education/Training Program
- Buffalo, NY
National Provider Identifier
1245859065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 100 High St
Buffalo, NY 14203-1126 - Phone
- (716) 859-5600
- NPI assigned
- Apr 12, 2020
- Last updated
- Apr 12, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | Primary |
Addresses
Primary practice location
100 High St
Buffalo, NY 14203-1126
Mailing address
1100 Campbell St
Williamsport, PA 17701-3025
Phone (570) 772-7398
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250516001093 | DE | Order and Referring Only - Diagnostic Radiology | 7810415510 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586649600000",
"number": "1245859065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 CAMPBELL ST",
"city": "WILLIAMSPORT",
"state": "PA",
"postal_code": "177013025",
"telephone_number": "570-772-7398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 HIGH ST",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142031126",
"telephone_number": "716-859-5600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAJJOUB",
"first_name": "KENAN",
"middle_name": "RODWAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-12",
"last_updated": "2020-04-12",
"certification_date": "2020-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.