Provider Demographics
NPI:1528408069
Name:JAGROOP, DEOLALL (LPN)
Entity Type:Individual
Prefix:
First Name:DEOLALL
Middle Name:
Last Name:JAGROOP
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8938 197TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2136
Mailing Address - Country:US
Mailing Address - Phone:917-921-7317
Mailing Address - Fax:
Practice Address - Street 1:8938 197TH ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2136
Practice Address - Country:US
Practice Address - Phone:917-921-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7671616164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse