Provider Demographics
NPI:1114993177
Name:JAWA, RANDEEP S (MD)
Entity Type:Individual
Prefix:
First Name:RANDEEP
Middle Name:S
Last Name:JAWA
Suffix:
Gender:M
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:STONY BROOK SURGICAL ASSOCIATES UFPC
Mailing Address - Street 2:SBUMC HSC LEVEL 19, RM 020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8191
Mailing Address - Country:US
Mailing Address - Phone:631-444-7875
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK SURGICAL ASSOCIATES UFPC
Practice Address - Street 2:SBUMC HSC LEVEL 19, RM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8191
Practice Address - Country:US
Practice Address - Phone:631-444-7875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230785208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH15437Medicare UPIN
NYRA2433Medicare ID - Type Unspecified
NY02178132Medicare ID - Type Unspecified