MEDICARE: DR. JAYA SARIN PRADHAN DMD

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	055578	NY
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	D-10260	MA
3	125Q00000X	Oral Medicine Dentistry	055578	NY

General Provider Information

NPI Number	:	1467600361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYA SARIN PRADHAN DMD

Provider Business Mailing Address
First Line	:	COLUMBIA - NY PRESBYTERIAN MEDICAL CENTER
Second Line	:	630 WEST 168TH STREET
City	:	NEW YORK
State	:	NY
Zip	:	10032
Country	:	US
Telephone Number	:	212-305-4552
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 W 168TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3720
Country	:	US
Telephone Number	:	212-305-6100
Fax Number	:

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

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	11/20/2025

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