Provider Demographics
NPI:1235475377
Name:KUMAR, JAYARAJ S (MD)
Entity Type:Individual
Prefix:MR
First Name:JAYARAJ
Middle Name:S
Last Name:KUMAR
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 1:30 PINE CONE LN
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5512
Mailing Address - Country:US
Mailing Address - Phone:631-348-7552
Mailing Address - Fax:
Practice Address - Street 1:30 PINE CONE LN
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5512
Practice Address - Country:US
Practice Address - Phone:631-348-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123553208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice