Active NPI
Devaraj Jeyamitra, M.D
- Internal Medicine Physician
- Commack, NY
National Provider Identifier
1194156612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 122286-1
- Practice address
- 22 Chardonnay Rd
Commack, NY 11725-1768 - Phone
- (631) 292-2610
- NPI assigned
- Dec 9, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 122286-1 | NY | Primary |
Addresses
Primary practice location
22 Chardonnay Rd
Commack, NY 11725-1768
Mailing address
22 Chardonnay Rd
Commack, NY 11725-1768
Phone (631) 292-2610
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122286-1 | NY | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1194156612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 CHARDONNAY RD",
"city": "COMMACK",
"state": "NY",
"postal_code": "117251768",
"telephone_number": "631-292-2610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 CHARDONNAY RD",
"city": "COMMACK",
"state": "NY",
"postal_code": "117251768",
"telephone_number": "631-292-2610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEYAMITRA",
"first_name": "DEVARAJ",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-12-09",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "122286-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Commack, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.