MEDICARE: DR. SOPHIA MITA JAGROOP M. D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	268335	NY

General Provider Information

NPI Number	:	1720285174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA MITA JAGROOP M. D

Provider Business Mailing Address
First Line	:	65-11 BOOTH STREET SUITE 1C
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-4184
Country	:	US
Telephone Number	:	718-806-1434
Fax Number	:	718-806-1435

Provider Business Practice Location Address
First Line	:	125-08 LIBERTY AVENUE
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11419-2234
Country	:	US
Telephone Number	:	718-806-1434
Fax Number	:	718-806-1435

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	10/24/2016

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