Healthcare Provider Details

I. General information

NPI: 1558482075
Provider Name (Legal Business Name): JASDEEP SIDANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 BOSTON POST ROAD
ORANGE CT
06477
US

IV. Provider business mailing address

521 BOSTON POST ROAD
ORANGE CT
06477
US

V. Phone/Fax

Practice location:
  • Phone: 203-523-0971
  • Fax: 203-529-3273
Mailing address:
  • Phone: 203-523-0971
  • Fax: 203-529-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number045143
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number045143
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: