Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 209335 | NY |
NPI | 1174511687 |
---|---|
Provider Name | Dr. Sundar Jagannath |
First Address | New York, NY 10029-6504 |
Second Address | New York, NY 10029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 26/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01259874 | (05) | NY |
B23726 | (02) | NY |