Healthcare Provider Details

I. General information

NPI: 1356397293
Provider Name (Legal Business Name): NAGALINGAM JEYALINGAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HUDSON VALLEY PROFESSIONAL PLZ
NEWBURGH NY
12550-3101
US

IV. Provider business mailing address

560 WHITE PLAINS RD SUITE 500
TARRYTOWN NY
10591-5113
US

V. Phone/Fax

Practice location:
  • Phone: 845-562-0760
  • Fax: 845-562-1019
Mailing address:
  • Phone: 914-333-5877
  • Fax: 914-333-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number126966
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: