MEDICARE: ST LAWRENCE INTERNISTS PC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1437223476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LAWRENCE INTERNISTS PC

Provider Business Mailing Address
First Line	:	267 ANDREWS ST
Second Line	:
City	:	MASSENA
State	:	NY
Zip	:	13662-3401
Country	:	US
Telephone Number	:	315-764-0221
Fax Number	:	315-764-1395

Provider Business Practice Location Address
First Line	:	267 ANDREWS ST
Second Line	:
City	:	MASSENA
State	:	NY
Zip	:	13662-3401
Country	:	US
Telephone Number	:	315-764-0221
Fax Number	:	315-764-1395

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAYANT J JHAVERI
Credential	:	M.D.
Telephone Number	:	315-764-0221

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	01/04/2013

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