Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | 259396 | NY |
NPI | 1992983456 |
---|---|
Provider Name | Dr. Jared Jagdeo |
First Address | Brooklyn, NY 11230-3971 |
Second Address | Brooklyn, NY 11203-2012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2008 |
Last Update Date | 25/10/2018 |