Healthcare Provider Details

I. General information

NPI: 1629080841
Provider Name (Legal Business Name): SARBJOT SINGH AJIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PARKWAY SOUTH JACOBI MEDICAL CENTER
BRONT NY
10461-0000
US

IV. Provider business mailing address

1400 PELHAM PARKWAY SOUTH JACOBI MEDICAL CENTER
BRONT NY
10461-0000
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5700
  • Fax:
Mailing address:
  • Phone: 718-918-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35087896
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number263345
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number35087896
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35087896
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number35087896
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: