1982121810 NPI number — JEET BHAIDASNA MEDICAL CARE PC

Table of content: DR. JESSICA FAYNE ROSE DO (NPI 1982833075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982121810 NPI number — JEET BHAIDASNA MEDICAL CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEET BHAIDASNA MEDICAL CARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982121810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 HOLIDAY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON BAYS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11946-2690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-712-7650
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64 COUNTY ROAD 39
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHAMPTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11968-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-702-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BHAIDASNA
Authorized Official First Name:
JEET
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-712-7650

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  282447-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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