Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 230785 | NY |
Y | 208600000X | Surgeon | 230785 | NY |
N | 2086S0102X | Surgical Critical Care | 230785 | NY |
N | 2086S0127X | Trauma Surgeon | 230785 | NY |
NPI | 1114993177 |
---|---|
Provider Name | Randeep S Jawa |
First Address | Stony Brook, NY 11794-8191 |
Second Address | Stony Brook, NY 11794-8191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 06/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H15437 | (02) | NY |