Provider Demographics
NPI:1598718983
Name:JIVA, TAJUDDIN MUHAMMAD (MD MPH MBA)
Entity Type:Individual
Prefix:
First Name:TAJUDDIN
Middle Name:MUHAMMAD
Last Name:JIVA
Suffix:
Gender:M
Credentials:MD MPH MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 SHERIDAN DR STE 5
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9478
Mailing Address - Country:US
Mailing Address - Phone:716-836-1388
Mailing Address - Fax:716-836-1399
Practice Address - Street 1:2545 SHERIDAN DR STE 5
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9478
Practice Address - Country:US
Practice Address - Phone:716-836-1388
Practice Address - Fax:716-836-1399
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY183042207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01447790Medicaid
NYF54961Medicare UPIN
NYRA1325Medicare ID - Type Unspecified