=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053604520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEHDHUN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2011
-----------------------------------------------------
Last Update Date | 01/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 WILLIAMSON ST STE 203
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07202-3671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-491-9597
-----------------------------------------------------
Fax | 973-261-5142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 715 OLD RARITAN RD
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08820-1021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-491-9597
-----------------------------------------------------
Fax | 973-261-5142
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MEHERWAN B JOSHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-491-9597
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------