Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 238095 | NY |
NPI | 1023254612 |
---|---|
Provider Name | Dr. Jaydeep Shivaji Kadam |
First Address | Syosset, NY 11791-4513 |
Second Address | Syosset, NY 11791-4513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2009 |
Last Update Date | 02/11/2010 |