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General NPI Number Information
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NPI Number | 1720285174
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Entity Type | Individual
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Provider Name | SOPHIA MITA JAGROOP M. D
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 125-08 LIBERTY AVENUE
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City | RICHMOND HILL
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State | NY
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Zip | 11419-2234
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Country | US
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Telephone | 718-806-1434
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Fax | 718-806-1435
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Provider Business Mailing Address
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Address Line | 65-11 BOOTH STREET SUITE 1C
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City | REGO PARK
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State | NY
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Zip | 11374-4184
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Country | US
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Telephone | 718-806-1434
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Fax | 718-806-1435
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 268335
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License Number State | NY
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