Provider Demographics
NPI:1588087258
Name:ROYCHOWDHURY, JAYANTA NARAYAN (BA)
Entity type:Individual
Prefix:
First Name:JAYANTA
Middle Name:NARAYAN
Last Name:ROYCHOWDHURY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 76TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6533
Mailing Address - Country:US
Mailing Address - Phone:347-421-9090
Mailing Address - Fax:
Practice Address - Street 1:3747 76 TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONHEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6533
Practice Address - Country:US
Practice Address - Phone:347-421-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRK 35008H 600486 235Medicaid