Provider Demographics
NPI:1942376777
Name:DOMADIA, JAYSUKHLAL J (RPH)
Entity Type:Individual
Prefix:
First Name:JAYSUKHLAL
Middle Name:J
Last Name:DOMADIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DAWN LN
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1135
Mailing Address - Country:US
Mailing Address - Phone:516-625-7098
Mailing Address - Fax:212-928-9780
Practice Address - Street 1:1600 ST. NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1135
Practice Address - Country:US
Practice Address - Phone:212-927-5994
Practice Address - Fax:212-928-9780
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist