Healthcare Provider Details

I. General information

NPI: 1083199129
Provider Name (Legal Business Name): JINAL VORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MAIN ST
MARLBOROUGH MA
01752-2690
US

IV. Provider business mailing address

220 RESERVOIR ST STE 9
NEEDHAM MA
02494-3133
US

V. Phone/Fax

Practice location:
  • Phone: 508-305-2766
  • Fax:
Mailing address:
  • Phone: 781-400-5920
  • Fax: 617-863-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858131
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: