Healthcare Provider Details

I. General information

NPI: 1114966397
Provider Name (Legal Business Name): JAGAN N PAHUJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BAY SHORE RD
NORTH BABYLON NY
11703-2823
US

IV. Provider business mailing address

1000 ZECKENDORF BLVD
GARDEN CITY NY
11530-2133
US

V. Phone/Fax

Practice location:
  • Phone: 631-586-2700
  • Fax: 631-586-3524
Mailing address:
  • Phone: 516-542-6880
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number116099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: