Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 26142 | WV |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 303507 | NY |
N | 207RG0300X | Geriatric Medicine | 26142 | WV |
NPI | 1104055227 |
---|---|
Provider Name | Dr. Sarada Jaimungal |
First Address | Oceanside, NY 11572-1551 |
Second Address | Merrick, NY 11566-4770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2009 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810029652 | MEDICAID (01) | WV |
WV5791A | (05) | WV |