Healthcare Provider Details

I. General information

NPI: 1912025321
Provider Name (Legal Business Name): JYOTI NARANG PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE NBV 15SOUTH5
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

14020 HOLLY AVE
FLUSHING NY
11355-3447
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-3917
  • Fax:
Mailing address:
  • Phone: 718-445-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number010862
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: