Provider Demographics
NPI:1871691659
Name:MAKAVANA, JAYESHKUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:JAYESHKUMAR
Middle Name:
Last Name:MAKAVANA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 E ROE BLVD
Mailing Address - Street 2:PATCHOGUE MEDICAL GROUP, LLP
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2631
Mailing Address - Country:US
Mailing Address - Phone:631-475-3900
Mailing Address - Fax:631-475-5166
Practice Address - Street 1:1 E ROE BLVD
Practice Address - Street 2:PATCHOGUE MEDICAL GROUP, LLP
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2631
Practice Address - Country:US
Practice Address - Phone:631-475-3900
Practice Address - Fax:631-475-5166
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-10-11
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Provider Licenses
StateLicense IDTaxonomies
NY229975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02522425Medicaid
NYH96041Medicare UPIN
NY000SUIMedicare ID - Type Unspecified