Provider Demographics
NPI:1629002050
Name:SINGH, JASJIT (DO)
Entity Type:Individual
Prefix:DR
First Name:JASJIT
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CORONA DR
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-4505
Mailing Address - Country:US
Mailing Address - Phone:631-841-6190
Mailing Address - Fax:631-789-0600
Practice Address - Street 1:366 BROADWAY
Practice Address - Street 2:BUILDING # 5
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2711
Practice Address - Country:US
Practice Address - Phone:631-841-6190
Practice Address - Fax:631-789-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1992191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01741079Medicaid
NY958353Medicare ID - Type Unspecified
NYG44404Medicare UPIN
NY3099978Medicare ID - Type Unspecified