Healthcare Provider Details

I. General information

NPI: 1851565840
Provider Name (Legal Business Name): SACHIN JAIN M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36-11 21ST ST
LONG ISLAND CITY NY
11106
US

IV. Provider business mailing address

42-09 28TH STREET
LONG ISLAND CITY NY
11101
US

V. Phone/Fax

Practice location:
  • Phone: 718-482-7772
  • Fax:
Mailing address:
  • Phone: 347-396-4892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number275338
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: