Provider Demographics
NPI:1316947047
Name:JAYABOSE, SOMASUNDARAM (MD)
Entity type:Individual
Prefix:
First Name:SOMASUNDARAM
Middle Name:
Last Name:JAYABOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:STE 1400
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-593-1729
Mailing Address - Fax:914-593-1790
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE. 1400
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-493-7997
Practice Address - Fax:914-594-4022
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1215572080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016681230002Medicaid
NY00228120Medicaid
NJ7169701Medicaid
NJ7169701Medicaid
NY342771Medicare PIN