Provider Demographics
NPI:1093026965
Name:JAIDEEP HOSKOTE MD PA
Entity Type:Organization
Organization Name:JAIDEEP HOSKOTE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSKOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-316-8584
Mailing Address - Street 1:4 BROOK CREST WAY
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1841
Mailing Address - Country:US
Mailing Address - Phone:904-316-8584
Mailing Address - Fax:
Practice Address - Street 1:4 BROOK CREST WAY
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1841
Practice Address - Country:US
Practice Address - Phone:904-316-8584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty