Provider Demographics
NPI:1114990033
Name:JHA, SANJAYA (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:SANJAYA
Middle Name:
Last Name:JHA
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLUMBIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3923
Mailing Address - Country:US
Mailing Address - Phone:845-473-1188
Mailing Address - Fax:845-473-0896
Practice Address - Street 1:1 COLUMBIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3923
Practice Address - Country:US
Practice Address - Phone:845-473-1188
Practice Address - Fax:845-473-0896
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231370207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02566925Medicaid
NY556P71Medicare ID - Type Unspecified
I05910Medicare UPIN