Basic Information
| Provider Information | |||||||||
| NPI: | 1811395437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANI | ||||||||
| FirstName: | MAHESHWAR | ||||||||
| MiddleName: | CHANDRAHAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1554 | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117900988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316384170 | ||||||||
| FaxNumber: | 6316384170 | ||||||||
| Practice Location | |||||||||
| Address1: | HSC T16 080 | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314441060 | ||||||||
| FaxNumber: | 6314441054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2014 | ||||||||
| LastUpdateDate: | 03/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 018278 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.