Provider Demographics
NPI:1316958572
Name:BAKSHI, JATINDER (MD)
Entity type:Individual
Prefix:DR
First Name:JATINDER
Middle Name:
Last Name:BAKSHI
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 1:21435 42ND AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2917
Mailing Address - Country:US
Mailing Address - Phone:718-229-4868
Mailing Address - Fax:
Practice Address - Street 1:21435 42ND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2971
Practice Address - Country:US
Practice Address - Phone:718-229-4868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196731-4W207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY196731-4WOtherSTATE LICENSE NUMBER
NYBB4433188OtherDEA NUMBER
NYBB4433188OtherDEA NUMBER
NY196731-4WOtherSTATE LICENSE NUMBER
NYG22389Medicare UPIN