Healthcare Provider Details

I. General information

NPI: 1710327721
Provider Name (Legal Business Name): JARUSHKA NAIDOO MB BCH BAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 MAIN ST APT 2L ROOSEVELT ISLAND
NEW YORK NY
10044-0084
US

IV. Provider business mailing address

475 MAIN ST APT 2L ROOSEVELT ISLAND
NEW YORK NY
10044-0084
US

V. Phone/Fax

Practice location:
  • Phone: 917-283-1522
  • Fax:
Mailing address:
  • Phone: 917-283-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberP87704
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: