Healthcare Provider Details

I. General information

NPI: 1568415990
Provider Name (Legal Business Name): SAPNA JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 INMAN AVE
COLONIA NJ
07067
US

IV. Provider business mailing address

1024 PARK AVE SUITE 6A
PLAINFIELD NJ
07060
US

V. Phone/Fax

Practice location:
  • Phone: 732-340-0007
  • Fax: 732-340-0777
Mailing address:
  • Phone: 908-222-8400
  • Fax: 908-222-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07300600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: