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NPI Code Detail

MEDICARE: ANMOL SHARMA JAIN PA-C

MEDICARE: ANMOL SHARMA JAIN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician031051NY
2363A00000XPhysician Assistant031051NY

General Provider Information

NPI Number : 1578349734
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANMOL SHARMA JAIN PA-C
Provider Business Mailing Address
First Line : 225 E 47TH ST APT 2D
Second Line :
City : NEW YORK
State : NY
Zip : 10017-2114
Country : US
Telephone Number : 980-345-9661
Fax Number :
Provider Business Practice Location Address
First Line : 1027 46TH AVE
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-5245
Country : US
Telephone Number : 980-345-9661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2023
Last Update Date : 03/12/2026

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