Healthcare Provider Details

I. General information

NPI: 1114900735
Provider Name (Legal Business Name): JYOTSNA THAPAR DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 OAK TREE AVE SUITE R
SOUTH PLAINFIELD NJ
07080-5100
US

IV. Provider business mailing address

13 TYSKA AVE
SAYREVILLE NJ
08872-1778
US

V. Phone/Fax

Practice location:
  • Phone: 908-222-8980
  • Fax: 908-222-8976
Mailing address:
  • Phone: 908-222-8980
  • Fax: 908-222-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD000278300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: