=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841001781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAYANTA K PAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2025
-----------------------------------------------------
Last Update Date | 01/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26284 PASEO SILLIN
-----------------------------------------------------
City | SAN JUAN CAPISTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-823-2941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26284 PASEO SILLIN
-----------------------------------------------------
City | SAN JUAN CAPISTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-823-2941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAYANTA KUMAR PAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-823-2941
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------