Provider Demographics
NPI:1104810183
Name:JHAVERI, SANJIV (MD)
Entity type:Individual
Prefix:
First Name:SANJIV
Middle Name:
Last Name:JHAVERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GLEN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2854
Mailing Address - Country:US
Mailing Address - Phone:516-484-7893
Mailing Address - Fax:516-484-5054
Practice Address - Street 1:70 GLEN ST
Practice Address - Street 2:STE 200
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2854
Practice Address - Country:US
Practice Address - Phone:516-484-7893
Practice Address - Fax:516-484-5054
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY195967207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01868657Medicaid
NY91Z071Medicare PIN
NY01868657Medicaid