Healthcare Provider Details

I. General information

NPI: 1699200873
Provider Name (Legal Business Name): JDJ MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E MAIN ST SUITE 403
NEWARK DE
19711-7128
US

IV. Provider business mailing address

314 E MAIN ST SUITE 403
NEWARK DE
19711-7128
US

V. Phone/Fax

Practice location:
  • Phone: 302-983-2646
  • Fax: 302-369-3093
Mailing address:
  • Phone: 302-983-2646
  • Fax: 302-369-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC1-0011584
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEET JOSHI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 302-983-2646