Individual
DR. JAGDISH GIDWANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
646 MAIN ST, PORT JEFFERSON, NY 11777-2235
(631) 928-6250
(631) 928-3010
Mailing address
646 MAIN ST, PORT JEFFERSON, NY 11777-2235
(631) 928-6250
(631) 928-3010
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
166492-1
NY
2084P0804X
Child & Adolescent Psychiatry Physician
166492-1
NY
Other
Enumeration date
01/24/2007
Last updated
01/18/2011
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