Healthcare Provider Details

I. General information

NPI: 1396075636
Provider Name (Legal Business Name): LATHA JADHAV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LATHA BALLEM M.D.

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SOUTH ST STE 220
MORRISTOWN NJ
07960-6422
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-3406
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-4222
  • Fax: 973-290-7050
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08647400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: