Provider Demographics
NPI:1114184173
Name:JAIN, SARGAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SARGAM
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 1:11 5TH AVE OFC 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4342
Mailing Address - Country:US
Mailing Address - Phone:917-318-3691
Mailing Address - Fax:347-478-5068
Practice Address - Street 1:31 WEST 10TH STREET
Practice Address - Street 2:SUITE 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-677-2985
Practice Address - Fax:347-478-5068
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2470982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry