Provider Demographics
NPI:1164046066
Name:SINGH JAGPAL, PADMINI
Entity Type:Individual
Prefix:
First Name:PADMINI
Middle Name:
Last Name:SINGH JAGPAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 BROADWAY # 1035
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1729
Mailing Address - Country:US
Mailing Address - Phone:917-725-7903
Mailing Address - Fax:
Practice Address - Street 1:240 ROCKAWAY AVE STE 3
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5841
Practice Address - Country:US
Practice Address - Phone:347-720-6199
Practice Address - Fax:516-593-0731
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXG81192TMedicaid