Healthcare Provider Details

I. General information

NPI: 1912971730
Provider Name (Legal Business Name): SNEH JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUTE 168 STE A6
BLACKWOOD NJ
08012-3207
US

IV. Provider business mailing address

1415 MARLTON PIKE E STE LL5
CHERRY HILL NJ
08034-2229
US

V. Phone/Fax

Practice location:
  • Phone: 856-232-6500
  • Fax: 856-232-0022
Mailing address:
  • Phone: 856-285-7200
  • Fax: 856-285-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37110
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA03711000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: