Healthcare Provider Details

I. General information

NPI: 1487603163
Provider Name (Legal Business Name): JAGTIANI URGENT& PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 S WASHINGTON AVE SUITE # 1
BERGENFIELD NJ
07621-3789
US

IV. Provider business mailing address

297 S WASHINGTON AVE SUITE # 1
BERGENFIELD NJ
07621-3789
US

V. Phone/Fax

Practice location:
  • Phone: 201-387-0087
  • Fax: 201-387-2232
Mailing address:
  • Phone: 201-387-0087
  • Fax: 201-387-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. RAJA KISHINCHAND JAGTIANI
Title or Position: MEMBER
Credential: M.D.
Phone: 201-387-0087