Provider Demographics
NPI:1063657062
Name:PANDEJEE, JAYESH
Entity Type:Individual
Prefix:MR
First Name:JAYESH
Middle Name:
Last Name:PANDEJEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5527
Mailing Address - Country:US
Mailing Address - Phone:732-821-0418
Mailing Address - Fax:
Practice Address - Street 1:1252 BOUND BROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1433
Practice Address - Country:US
Practice Address - Phone:732-302-9029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045104-1183500000X
NJ28RI01996700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist