Individual
JAYASRI INDARAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9709 101ST AVE, OZONE PARK, NY 11416-2523
(718) 641-5555
(718) 641-6677
Mailing address
10 CARRIAGE DR, OLD WESTBURY, NY 11568-1323
(516) 655-3327
(516) 801-2070
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
193883
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01528252
—
NY
Enumeration date
07/29/2005
Last updated
12/05/2013
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