Provider Demographics
NPI:1710040860
Name:JHAGROO, GEORGE VISHNUDATT SR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:VISHNUDATT
Last Name:JHAGROO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:VISHNUDATT
Other - Last Name:JHAGROO
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12508 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2234
Mailing Address - Country:US
Mailing Address - Phone:718-738-2614
Mailing Address - Fax:
Practice Address - Street 1:12508 LIBERTY AVE
Practice Address - Street 2:12508 LIBERTY AVE
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2234
Practice Address - Country:US
Practice Address - Phone:718-738-2614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139427207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01664Medicare PIN