Provider Demographics
NPI:1144464280
Name:JAI K JALAJ MD PC
Entity type:Organization
Organization Name:JAI K JALAJ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-897-3210
Mailing Address - Street 1:66 MIDDLEBUSH RD
Mailing Address - Street 2:SUITE M206
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4098
Mailing Address - Country:US
Mailing Address - Phone:845-897-3210
Mailing Address - Fax:845-897-3290
Practice Address - Street 1:66 MIDDLEBUSH RD
Practice Address - Street 2:SUITE M206
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4098
Practice Address - Country:US
Practice Address - Phone:845-897-3210
Practice Address - Fax:845-897-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166168207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty