Provider Demographics
NPI:1013973841
Name:BAPNA, JITENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:
Last Name:BAPNA
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 1:8154 GOLDEN OAK CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8502
Mailing Address - Country:US
Mailing Address - Phone:716-639-0639
Mailing Address - Fax:
Practice Address - Street 1:12845 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1241
Practice Address - Country:US
Practice Address - Phone:716-937-3255
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA2419Medicare ID - Type Unspecified
NYG60295Medicare UPIN