Healthcare Provider Details

I. General information

NPI: 1316947047
Provider Name (Legal Business Name): SOMASUNDARAM JAYABOSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE. 1400
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

19 BRADHURST AVE STE 1400
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7997
  • Fax: 914-594-4022
Mailing address:
  • Phone: 914-593-1729
  • Fax: 914-593-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number121557
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: