Provider Demographics
NPI:1467600361
Name:PRADHAN, JAYA SARIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAYA
Middle Name:SARIN
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JAYA
Other - Middle Name:
Other - Last Name:SARIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:COLUMBIA - NY PRESBYTERIAN MEDICAL CENTER
Mailing Address - Street 2:630 WEST 168TH STREET
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-4552
Mailing Address - Fax:
Practice Address - Street 1:MASSACHUSETTS GENERAL HOSPITAL
Practice Address - Street 2:55 FRUIT STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055578122300000X
MAD-10260204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery