Provider Demographics
NPI:1114900735
Name:THAPAR, JYOTSNA (DPM)
Entity Type:Individual
Prefix:DR
First Name:JYOTSNA
Middle Name:
Last Name:THAPAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TYSKA AVE
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1778
Mailing Address - Country:US
Mailing Address - Phone:908-222-8980
Mailing Address - Fax:908-222-8976
Practice Address - Street 1:908 OAK TREE AVE
Practice Address - Street 2:SUITE R
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5100
Practice Address - Country:US
Practice Address - Phone:908-222-8980
Practice Address - Fax:908-222-8976
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD000278300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0076449Medicaid
U98963Medicare UPIN
NJ0076449Medicaid