Provider Demographics
NPI:1790754125
Name:MUKHOPADHAY, JAYATI (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:JAYATI
Middle Name:
Last Name:MUKHOPADHAY
Suffix:
Gender:F
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BALL ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3413
Mailing Address - Country:US
Mailing Address - Phone:973-374-8889
Mailing Address - Fax:973-374-1034
Practice Address - Street 1:60 BALL ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3413
Practice Address - Country:US
Practice Address - Phone:973-374-8889
Practice Address - Fax:973-374-1034
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA040336207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1881809Medicaid
NJMA040336OtherMEDICAL LICENSE
NJMA040336OtherMEDICAL LICENSE
0000454925Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER