Healthcare Provider Details

I. General information

NPI: 1386885796
Provider Name (Legal Business Name): JAY K PAHADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TOMPKINS EAST 2 DEPT OF RADIOLOGY- YALE UNVERSITY
NEW HAVEN CT
06520-8042
US

IV. Provider business mailing address

PO BOX 208042 YALE RADIOLOGY
NEW HAVEN CT
06020-8042
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number229188
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number49706
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: