Provider Demographics
NPI:1922064799
Name:GONA, JAYAKUMARI (MD)
Entity Type:Individual
Prefix:
First Name:JAYAKUMARI
Middle Name:
Last Name:GONA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3435 MAIN ST 105 PARKER HALL #10
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-834-8194
Mailing Address - Fax:716-829-2348
Practice Address - Street 1:64 DAVISON CT
Practice Address - Street 2:
Practice Address - City:LOCPORT
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-433-3572
Practice Address - Fax:716-829-2348
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2010-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY135032207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01789582Medicaid
NY01789582Medicaid
NYH04197Medicare UPIN