Healthcare Provider Details

I. General information

NPI: 1972295327
Provider Name (Legal Business Name): NIDHI JAIN M.B.B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

UCONN HEALTH GRADUATE MEDICAL EDUCATION 263 FARMINGTON AVENUE
FARMINGTON CT
06030-1921
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6366
  • Fax: 617-636-6361
Mailing address:
  • Phone: 860-679-2147
  • Fax: 860-679-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number3020132
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: