Basic Information
| Provider Information | |||||||||
| NPI: | 1629046073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANEJA | ||||||||
| FirstName: | SANJEEV | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6900 E CAMELBACK RD STE 700 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852512400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078963055 | ||||||||
| FaxNumber: | 6233226147 | ||||||||
| Practice Location | |||||||||
| Address1: | 6900 E CAMELBACK RD STE 700 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852512400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808094829 | ||||||||
| FaxNumber: | 6233226147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 04/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME118491 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 02510290 | 05 | NY | MEDICAID | ME118491 | 01 | FL | FLORIDA MEDICAL LICENSE | OTHER |