Provider Demographics
NPI:1356313829
Name:JAIN, VINAYENDRA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAYENDRA
Middle Name:KUMAR
Last Name:JAIN
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 1:10 BONNIE LYNN CT
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3040
Mailing Address - Country:US
Mailing Address - Phone:516-365-2769
Mailing Address - Fax:
Practice Address - Street 1:600 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1706
Practice Address - Country:US
Practice Address - Phone:718-245-2629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00435534Medicaid
NY00435534Medicaid
NYE40357Medicare UPIN