Healthcare Provider Details

I. General information

NPI: 1609980366
Provider Name (Legal Business Name): DR. JAGDISH C CHUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 MOUNTAIN AVE
HACKETTSTOWN NJ
07840-2412
US

IV. Provider business mailing address

182 MOUNTAIN AVE
HACKETTSTOWN NJ
07840-2412
US

V. Phone/Fax

Practice location:
  • Phone: 908-852-8787
  • Fax: 908-852-8187
Mailing address:
  • Phone: 908-852-8787
  • Fax: 908-852-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA67688
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: