Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 197164 | NY |
NPI | 1023059284 |
---|---|
Provider Name | Sangam B Jhaveri |
First Address | Rego Park, NY 11374-4184 |
Second Address | Forest Hills, NY 11375-2029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 03/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01636626 | (05) | NY |
02514 | MEDICARE (01) |