MEDICARE: BIPINCHANDRA JAGJIVAN

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	2085R0202X	Diagnostic Radiology Physician	029720	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619973823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIPINCHANDRA JAGJIVAN

Provider Business Mailing Address
First Line	:	385 MAIN ST SOUTH
Second Line	:	UNION SQUARE BLDG #1 NVRA IMAGING NETWORK
City	:	SOUTHBURY
State	:	CT
Zip	:	06488
Country	:	US
Telephone Number	:	203-264-7999
Fax Number	:	203-264-7477

Provider Business Practice Location Address
First Line	:	385 MAIN ST SOUTH
Second Line	:	UNION SQUARE BLDG #1 NVRA IMAGING NETWORK
City	:	SOUTHBURY
State	:	CT
Zip	:	06488
Country	:	US
Telephone Number	:	203-264-7999
Fax Number	:	203-264-7477

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/22/2014

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