Healthcare Provider Details

I. General information

NPI: 1124124649
Provider Name (Legal Business Name): AMI JATINKUMAR JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 US HWY 202 206 N PEDIAHEALTH MEDICAL ASSOCIATES
BRIDGEWATER NJ
08807
US

IV. Provider business mailing address

13 WHITE MEADOW ROAD
HILLSBOROUGH NJ
08844
US

V. Phone/Fax

Practice location:
  • Phone: 908-722-5444
  • Fax: 908-722-5071
Mailing address:
  • Phone: 908-281-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA69522
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: