MEDICARE: DR. GEORGE VISHNUDATT JHAGROO SR. M.D

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	207RG0100X	Gastroenterology Physician	139427	NY

General Provider Information

NPI Number	:	1710040860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE VISHNUDATT JHAGROO SR. M.D

Provider Business Mailing Address
First Line	:	12508 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2234
Country	:	US
Telephone Number	:	718-738-2614
Fax Number	:

Provider Business Practice Location Address
First Line	:	12508 LIBERTY AVE
Second Line	:	12508 LIBERTY AVE
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2234
Country	:	US
Telephone Number	:	718-738-2614
Fax Number	:

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	10/16/2009

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