MEDICARE: RANDEEP S JAWA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	230785	NY
2	2086S0102X	Surgical Critical Care Physician	230785	NY
3	2086S0127X	Trauma Surgery Physician	230785	NY

General Provider Information

NPI Number	:	1114993177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDEEP S JAWA MD

Provider Business Mailing Address
First Line	:	STONY BROOK SURGICAL ASSOCIATES UFPC
Second Line	:	SBUMC HSC LEVEL 19, RM 020
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8191
Country	:	US
Telephone Number	:	631-444-7875
Fax Number	:

Provider Business Practice Location Address
First Line	:	STONY BROOK SURGICAL ASSOCIATES UFPC
Second Line	:	SBUMC HSC LEVEL 19, RM 020
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8191
Country	:	US
Telephone Number	:	631-444-7875
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	09/06/2013

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