Provider Demographics
NPI:1063501104
Name:SUBRAMANI, JAISHREE (MD,MPH)
Entity Type:Individual
Prefix:
First Name:JAISHREE
Middle Name:
Last Name:SUBRAMANI
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 M0NTAUK HIGHWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1201
Mailing Address - Country:US
Mailing Address - Phone:631-422-4343
Mailing Address - Fax:516-626-0347
Practice Address - Street 1:500 M0NTAUK HIGHWAY
Practice Address - Street 2:SUITE B
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-1201
Practice Address - Country:US
Practice Address - Phone:631-422-4343
Practice Address - Fax:631-661-3775
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE95128Medicare UPIN
NY94F351Medicare ID - Type Unspecified