Provider Demographics
NPI:1205144847
Name:JASJIT K. PAWHA, PHYSICIAN, P.C.
Entity type:Organization
Organization Name:JASJIT K. PAWHA, PHYSICIAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASJIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:PAWHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-657-9700
Mailing Address - Street 1:7844 81ST ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7633
Mailing Address - Country:US
Mailing Address - Phone:718-657-9700
Mailing Address - Fax:
Practice Address - Street 1:7844 81ST ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7633
Practice Address - Country:US
Practice Address - Phone:718-657-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
NY151062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty