Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 138690 | NY |
NPI | 1033103882 |
---|---|
Provider Name | Dr. Nadubeethi Jayaram |
First Address | Staten Island, NY 10304-4405 |
Second Address | Staten Island, NY 10304-4419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 15/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01838683 | (05) | NY |
C57416 | (02) | NY |