=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437531308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JSK JSN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2015
-----------------------------------------------------
Last Update Date | 06/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14807 E COLONIAL DR SUITE 112
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32826-5122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-250-6742
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14807 E COLONIAL DR SUITE 112
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32826-5122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-289-1951
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. KAUSHIKKUMAR K. PATEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 321-289-1951
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------