Provider Demographics
NPI:1033343702
Name:DEITCH, JANA LORI (MD)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:LORI
Last Name:DEITCH
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 1:48 ROUTE 25A STE 301
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1454
Mailing Address - Country:US
Mailing Address - Phone:631-862-3171
Mailing Address - Fax:631-862-3180
Practice Address - Street 1:48 ROUTE 25A STE 301
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1454
Practice Address - Country:US
Practice Address - Phone:631-862-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2794162086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology