Healthcare Provider Details

I. General information

NPI: 1649577560
Provider Name (Legal Business Name): JESSIE DEWANJEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2011
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 TUCKAHOE RD APT-2D
YONKERS NY
10710-5259
US

IV. Provider business mailing address

720 TUCKAHOE RD APT-2D
YONKERS NY
10710-5259
US

V. Phone/Fax

Practice location:
  • Phone: 757-243-6651
  • Fax:
Mailing address:
  • Phone: 757-234-6651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number11111
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: