Provider Demographics
NPI:1417721788
Name:CHRISANDUT, JAIPRAKASH
Entity Type:Individual
Prefix:
First Name:JAIPRAKASH
Middle Name:
Last Name:CHRISANDUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11518 132ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2610
Mailing Address - Country:US
Mailing Address - Phone:347-848-3698
Mailing Address - Fax:
Practice Address - Street 1:11518 132ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2610
Practice Address - Country:US
Practice Address - Phone:347-848-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY739244-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse