Provider Demographics
NPI:1467433003
Name:JINDAL, PAWAN KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAWAN
Middle Name:KUMAR
Last Name:JINDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:27 STOUTENBURGH DR
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2053
Mailing Address - Country:US
Mailing Address - Phone:845-229-9660
Mailing Address - Fax:
Practice Address - Street 1:21 FOX ST STE 104
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-431-2400
Practice Address - Fax:845-473-0026
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126517208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00790285Medicaid
NY00790285Medicaid
002D8020Medicare ID - Type Unspecified