Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 253596 | NY |
NPI | 1710123930 |
---|---|
Provider Name | Dr. Jai Swarna Perumal |
First Address | New Rochelle, NY 10804-1038 |
Second Address | New York, NY 10021-5663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2008 |
Last Update Date | 04/04/2016 |