Healthcare Provider Details

I. General information

NPI: 1043255250
Provider Name (Legal Business Name): JASJIT S KOCHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SOUTH HOWELL AVENUE STONY BROOK EXTENDED CARE
CENTEREACH NY
11720
US

IV. Provider business mailing address

STONY BROOK INTERNIST P.O. BOX 36305
NEWARK NJ
07188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 631-542-0550
  • Fax: 631-650-7473
Mailing address:
  • Phone: 631-542-0550
  • Fax: 631-650-7473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number193648
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: