Healthcare Provider Details

I. General information

NPI: 1205144847
Provider Name (Legal Business Name): JASJIT K. PAWHA, PHYSICIAN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7844 81ST ST
GLENDALE NY
11385-7633
US

IV. Provider business mailing address

7844 81ST ST
GLENDALE NY
11385-7633
US

V. Phone/Fax

Practice location:
  • Phone: 718-657-9700
  • Fax:
Mailing address:
  • Phone: 718-657-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number151062
License Number StateNY

VIII. Authorized Official

Name: JASJIT K. PAWHA
Title or Position: PRESIDENT
Credential:
Phone: 718-657-9700