Provider Demographics
NPI:1285656116
Name:KOMERATH, JAYASEKHARAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYASEKHARAN
Middle Name:
Last Name:KOMERATH
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 1:13618 39TH AVE
Mailing Address - Street 2:SUITE 906
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5516
Mailing Address - Country:US
Mailing Address - Phone:718-961-8817
Mailing Address - Fax:718-961-8815
Practice Address - Street 1:13618 39TH AVE
Practice Address - Street 2:SUITE 906
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5516
Practice Address - Country:US
Practice Address - Phone:718-961-8817
Practice Address - Fax:718-961-8815
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08L881Medicare ID - Type UnspecifiedNYC OFFICE
NYC08954Medicare UPIN
NY06145GMedicare ID - Type UnspecifiedFLUSHING