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General NPI Number Information
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NPI Number | 1134447493
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Entity Type | Individual
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Provider Name | NIREN JASUTKAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 1 MAYWOOD AVE
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City | MAYWOOD
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State | NJ
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Zip | 07607-1001
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Country | US
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Telephone | 551-257-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 219 N BROAD ST FL 5 DIVISION OF GASTROENTEROLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1507
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Country | US
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Telephone | 215-762-6072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | LP01844
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25MA09962100
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License Number State | NJ
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