Healthcare Provider Details

I. General information

NPI: 1407205206
Provider Name (Legal Business Name): JAY SANGANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 CRANBURY RD
EAST BRUNSWICK NJ
08816-3610
US

IV. Provider business mailing address

579A CRANBURY RD
EAST BRUNSWICK NJ
08816-5426
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-7000
  • Fax: 215-762-7765
Mailing address:
  • Phone: 732-390-0040
  • Fax: 732-955-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA11376100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number25MA11376100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: