Provider Demographics
NPI:1699796896
Name:JHAVERI, JIGNA DESAI (MD)
Entity type:Individual
Prefix:DR
First Name:JIGNA
Middle Name:DESAI
Last Name:JHAVERI
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 1:532 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 142
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3672
Mailing Address - Country:US
Mailing Address - Phone:516-931-0041
Mailing Address - Fax:
Practice Address - Street 1:1324 MOTOR PKWY
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5262
Practice Address - Country:US
Practice Address - Phone:631-963-7700
Practice Address - Fax:631-232-0147
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191821-12085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY737721Medicare ID - Type Unspecified
NYG40812Medicare UPIN