Provider Demographics
NPI:1528337383
Name:KRISHANA K. JAJOO, PHYSICIAN, P.C.
Entity type:Organization
Organization Name:KRISHANA K. JAJOO, PHYSICIAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAJOO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:516-354-5300
Mailing Address - Street 1:1575 HILLSIDE AVE
Mailing Address - Street 2:SUITE:105
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2521
Mailing Address - Country:US
Mailing Address - Phone:516-354-5300
Mailing Address - Fax:516-354-5335
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:SUITE:105
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2501
Practice Address - Country:US
Practice Address - Phone:516-354-5300
Practice Address - Fax:516-354-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY704691Medicare PIN