Provider Demographics
NPI:1124054671
Name:WADHWANI, JAI G (MD)
Entity type:Individual
Prefix:DR
First Name:JAI
Middle Name:G
Last Name:WADHWANI
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 1:6460 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5838
Mailing Address - Country:US
Mailing Address - Phone:716-634-5100
Mailing Address - Fax:716-634-5134
Practice Address - Street 1:6460 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5838
Practice Address - Country:US
Practice Address - Phone:716-634-5100
Practice Address - Fax:716-634-5134
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194482207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005233430005OtherBLUE CROSS/BLUE SHIELD
NY00010185201OtherUNIVERA
NY01667014Medicaid
NY2108112OtherINDEPENDENT HEALTH
NYF80731Medicare UPIN
NY01667014Medicaid