Provider Demographics
NPI:1679930051
Name:SIWAZURI, JAIRU (RN)
Entity Type:Individual
Prefix:
First Name:JAIRU
Middle Name:
Last Name:SIWAZURI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 NEW HAVEN AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5115
Mailing Address - Country:US
Mailing Address - Phone:347-484-1507
Mailing Address - Fax:
Practice Address - Street 1:1710 NEW HAVEN AVE APT 7
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5115
Practice Address - Country:US
Practice Address - Phone:347-484-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657996163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse