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General NPI Number Information
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NPI Number | 1285656116
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Entity Type | Individual
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Provider Name | JAYASEKHARAN KOMERATH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 12/19/2008
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Provider Practice Location Address
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Address Line | 13618 39TH AVE SUITE 906
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City | FLUSHING
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State | NY
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Zip | 11354-5516
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Country | US
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Telephone | 718-961-8817
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Fax | 718-961-8815
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Provider Business Mailing Address
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Address Line | 13618 39TH AVE SUITE 906
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City | FLUSHING
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State | NY
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Zip | 11354-5516
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Country | US
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Telephone | 718-961-8817
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Fax | 718-961-8815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 130031
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License Number State | NY
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