Provider Demographics
NPI:1326031535
Name:JASTY, BABU NAGASURI (MD)
Entity Type:Individual
Prefix:
First Name:BABU
Middle Name:NAGASURI
Last Name:JASTY
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 1:6414 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3929
Mailing Address - Country:US
Mailing Address - Phone:718-234-2300
Mailing Address - Fax:718-234-0098
Practice Address - Street 1:6414 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3929
Practice Address - Country:US
Practice Address - Phone:718-234-2300
Practice Address - Fax:718-234-0098
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141049207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00579740Medicaid
NY00579740Medicaid
NYB14971Medicare UPIN