Healthcare Provider Details

I. General information

NPI: 1255797783
Provider Name (Legal Business Name): DR. NIVETA JEYAKUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 3RD AVE
NEW YORK NY
10003-2503
US

IV. Provider business mailing address

196 3RD AVE
NEW YORK NY
10003-2503
US

V. Phone/Fax

Practice location:
  • Phone: 212-598-0339
  • Fax:
Mailing address:
  • Phone: 212-598-0339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number061008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: