Provider Demographics
NPI:1740240282
Name:JHAVERI, JAYANT J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANT
Middle Name:J
Last Name:JHAVERI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:267 ANDREWS ST
Mailing Address - Street 2:ST. LAWRENCE INTERNISTS
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-3401
Mailing Address - Country:US
Mailing Address - Phone:315-764-0221
Mailing Address - Fax:315-764-1395
Practice Address - Street 1:267 ANDREWS ST
Practice Address - Street 2:ST. LAWRENCE INTERNISTS
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-3401
Practice Address - Country:US
Practice Address - Phone:315-764-0221
Practice Address - Fax:315-764-1395
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2010-08-23
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Provider Licenses
StateLicense IDTaxonomies
NY176155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01096455Medicaid
NY01096455Medicaid
CC9358Medicare ID - Type Unspecified