Healthcare Provider Details

I. General information

NPI: 1306171665
Provider Name (Legal Business Name): AMISHA JAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 LANARK RD STE 200
CENTER VALLEY PA
18034-8697
US

IV. Provider business mailing address

5425 LANARK RD STE 200
CENTER VALLEY PA
18034-8697
US

V. Phone/Fax

Practice location:
  • Phone: 917-704-7448
  • Fax:
Mailing address:
  • Phone: 917-704-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD494013
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: