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General NPI Number Information
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NPI Number | 1982121810
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Entity Type | Organization
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Legal Business Name | JEET BHAIDASNA MEDICAL CARE PC
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 08/22/2017
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Provider Practice Location Address
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Address Line | 64 COUNTY ROAD 39
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5215
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Country | US
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Telephone | 631-702-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 8 HOLIDAY CT
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City | HAMPTON BAYS
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State | NY
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Zip | 11946-2690
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Country | US
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Telephone | 516-712-7650
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEET BHAIDASNA
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Credential | DO
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Telephone | 516-712-7650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 282447-1
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License Number State | NY
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