MEDICARE: SANJEEV JAIN PHYSICIAN P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	225429	NY

General Provider Information

NPI Number	:	1033549639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANJEEV JAIN PHYSICIAN P.C.

Provider Business Mailing Address
First Line	:	24738 77TH CRES
Second Line	:
City	:	BELLEROSE
State	:	NY
Zip	:	11426-1863
Country	:	US
Telephone Number	:	516-457-9348
Fax Number	:

Provider Business Practice Location Address
First Line	:	10810 72ND AVE
Second Line	:	4TH FLOOR
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5338
Country	:	US
Telephone Number	:	718-544-7950
Fax Number	:	718-544-7951

Authorized Official
Title or Position	:	CHIEF
Name	:	DR. SANJEEV JAIN
Credential	:	M.D.
Telephone Number	:	516-457-9348

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	12/21/2016

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