Provider Demographics
NPI:1871637843
Name:JAISWAL, ARUN (MD)
Entity Type:Individual
Prefix:
First Name:ARUN
Middle Name:
Last Name:JAISWAL
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 1:584 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5022
Mailing Address - Country:US
Mailing Address - Phone:631-689-4538
Mailing Address - Fax:
Practice Address - Street 1:584 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5022
Practice Address - Country:US
Practice Address - Phone:631-689-4538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193833207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY193833OtherHIP
NY329752OtherPHCS
NYP379217OtherOXFORD
NY01672522Medicaid
NY0568172OtherAETNA
NY65466OtherVYTRA
NY751241OtherEMPIRE BCBS
NY6010710OtherGHI
NY751241OtherEMPIRE BCBS
NY193833OtherHIP
NYG13267Medicare UPIN