Provider Demographics
NPI:1710037627
Name:SINGH, JAGANNATH (MD)
Entity Type:Individual
Prefix:
First Name:JAGANNATH
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8769 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3803
Mailing Address - Country:US
Mailing Address - Phone:718-336-4499
Mailing Address - Fax:718-336-2013
Practice Address - Street 1:8769 14TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3803
Practice Address - Country:US
Practice Address - Phone:718-336-4499
Practice Address - Fax:718-336-2013
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1154422086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY566381Medicare ID - Type Unspecified
B77797Medicare UPIN