Healthcare Provider Details

I. General information

NPI: 1114960705
Provider Name (Legal Business Name): JIGISHA SHANKARBHAI CHAUDHARY M.B.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 SAINT GEORGES AVE
COLONIA NJ
07067-3425
US

IV. Provider business mailing address

1503 SAINT GEORGES AVE
COLONIA NJ
07067-3425
US

V. Phone/Fax

Practice location:
  • Phone: 732-382-8111
  • Fax: 732-382-7766
Mailing address:
  • Phone: 732-382-8111
  • Fax: 732-382-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07812900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: