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General NPI Number Information
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NPI Number | 1457629453
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Entity Type | Organization
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Legal Business Name | JAYAKUMAR THOTAMBILU, PHYSICIAN, P.C.
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 522 S 4TH ST SUITE 1300
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City | FULTON
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State | NY
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Zip | 13069-2946
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Country | US
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Telephone | 315-592-4000
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Fax | 315-593-3222
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Provider Business Mailing Address
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Address Line | 522 S 4TH ST SUITE 1300
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City | FULTON
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State | NY
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Zip | 13069-2946
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Country | US
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Telephone | 315-592-4001
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Fax | 315-593-3222
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JAYAKUMAR THOTAMBILU
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Credential | M.D.
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Telephone | 315-592-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 001219
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License Number State | NY
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