Provider Demographics
NPI:1871933069
Name:GUNRAJ, CECIL GEORGE
Entity type:Individual
Prefix:MR
First Name:CECIL
Middle Name:GEORGE
Last Name:GUNRAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4462 MURDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1109
Mailing Address - Country:US
Mailing Address - Phone:347-920-2991
Mailing Address - Fax:
Practice Address - Street 1:4462 MURDOCK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1109
Practice Address - Country:US
Practice Address - Phone:347-920-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY689373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist