Healthcare Provider Details

I. General information

NPI: 1669561908
Provider Name (Legal Business Name): JAYANTA R ROY-CHOWDHURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MONTEFIORE MEDICAL PARK 1515 BLONDELL AVENUE, STE. 200
BRONX NY
10461
US

IV. Provider business mailing address

139 WOODHOLLOW LN
NEW ROCHELLE NY
10804-3435
US

V. Phone/Fax

Practice location:
  • Phone: 866-633-8255
  • Fax:
Mailing address:
  • Phone: 866-633-8255
  • Fax: 718-430-8975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number124490
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: