Healthcare Provider Details

I. General information

NPI: 1780145383
Provider Name (Legal Business Name): ARCHANA JAYAKUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SPRINGFIELD AVE FL 3
SUMMIT NJ
07901-4055
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-934-0555
  • Fax: 908-934-0556
Mailing address:
  • Phone: 844-362-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB11912100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number25MB11912100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: