Provider Demographics
NPI:1902887235
Name:JAIN, SANJEEVANI (MD)
Entity Type:Individual
Prefix:
First Name:SANJEEVANI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 SPARTA AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1777
Mailing Address - Country:US
Mailing Address - Phone:973-729-2991
Mailing Address - Fax:973-729-7641
Practice Address - Street 1:89 SPARTA AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1777
Practice Address - Country:US
Practice Address - Phone:973-729-2991
Practice Address - Fax:973-729-7641
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA541362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F04936Medicare UPIN