Provider Demographics
NPI:1669681888
Name:JAYASUDHA INC.
Entity type:Organization
Organization Name:JAYASUDHA INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUDHAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYAPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-265-8110
Mailing Address - Street 1:767 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6332
Mailing Address - Country:US
Mailing Address - Phone:212-265-8110
Mailing Address - Fax:212-262-1614
Practice Address - Street 1:767 9TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6332
Practice Address - Country:US
Practice Address - Phone:212-265-8110
Practice Address - Fax:212-262-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01028431Medicaid
NY4096910001Medicare NSC