Healthcare Provider Details

I. General information

NPI: 1790043040
Provider Name (Legal Business Name): JOSHAN K SHAJAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E PUTNAM AVE STE 1B
COS COB CT
06807-2606
US

IV. Provider business mailing address

212 BIBLE ST
COS COB CT
06807-1322
US

V. Phone/Fax

Practice location:
  • Phone: 203-489-5442
  • Fax: 203-325-3270
Mailing address:
  • Phone: 646-652-1791
  • Fax: 888-981-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA155675
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number53782
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: