Provider Demographics
NPI:1720285174
Name:JAGROOP, SOPHIA MITA (M D)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:MITA
Last Name:JAGROOP
Suffix:
Gender:F
Credentials:M D
Other - Prefix:DR
Other - First Name:SOPHIA
Other - Middle Name:MITA
Other - Last Name:JHAGROO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:65-11 BOOTH STREET SUITE 1C
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4184
Mailing Address - Country:US
Mailing Address - Phone:718-806-1434
Mailing Address - Fax:718-806-1435
Practice Address - Street 1:125-08 LIBERTY AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2234
Practice Address - Country:US
Practice Address - Phone:718-806-1434
Practice Address - Fax:718-806-1435
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268335207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology