Individual
JASKAREN RANDHAWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1501 BROADWAY, #502, NEW YORK, NY 10036-5601
(212) 575-7740
Mailing address
1501 BROADWAY, #502, NEW YORK, NY 10036-5601
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0582191
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04289305
—
NY
Enumeration date
05/06/2014
Last updated
01/22/2017
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