MEDICARE: JSN PRIMARY CARE PHYSICIAN

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	251G00000X	Community Based Hospice Care Agency
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1518559053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JSN PRIMARY CARE PHYSICIAN

Provider Business Mailing Address
First Line	:	10302 LEFFERTS BLVD
Second Line	:
City	:	S RICHMOND HL
State	:	NY
Zip	:	11419-2012
Country	:	US
Telephone Number	:	609-592-2293
Fax Number	:	347-719-3010

Provider Business Practice Location Address
First Line	:	10302 LEFFERTS BLVD
Second Line	:
City	:	S RICHMOND HL
State	:	NY
Zip	:	11419-2012
Country	:	US
Telephone Number	:	609-592-2293
Fax Number	:	347-719-3010

Authorized Official
Title or Position	:	OWNER
Name	:	JASVENDAR SINGH NANDRA
Credential	:	MD
Telephone Number	:	407-782-7448

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	03/08/2021

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Directions to “JSN PRIMARY CARE PHYSICIAN ” Practice Location

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