Healthcare Provider Details

I. General information

NPI: 1396297289
Provider Name (Legal Business Name): GIRISH JHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date: JHA GIRISH 1251 CAMERO WAY FREMONT CA 94539 34 SHETLAND RD EAST BRUNSWICK NJ 08816
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SHETLAND RD
EAST BRUNSWICK NJ
08816-4340
US

IV. Provider business mailing address

1251 CAMERO WAY
FREMONT CA
94539-3787
US

V. Phone/Fax

Practice location:
  • Phone: 732-642-8895
  • Fax:
Mailing address:
  • Phone: 732-642-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: