Healthcare Provider Details

I. General information

NPI: 1205571577
Provider Name (Legal Business Name): DR. JASBIR SINGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 HAMBURG TPKE STE 202
WAYNE NJ
07470-2166
US

IV. Provider business mailing address

342 HAMBURG TPKE STE 202
WAYNE NJ
07470-2166
US

V. Phone/Fax

Practice location:
  • Phone: 862-346-5716
  • Fax:
Mailing address:
  • Phone: 862-346-5716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number25MA13265800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: