Provider Demographics
NPI:1154471134
Name:JINDAL, DEEPAK
Entity Type:Individual
Prefix:MR
First Name:DEEPAK
Middle Name:
Last Name:JINDAL
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 1:438 HERRICK DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2009
Mailing Address - Country:US
Mailing Address - Phone:973-343-6656
Mailing Address - Fax:
Practice Address - Street 1:17 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NETCONG
Practice Address - State:NJ
Practice Address - Zip Code:07857-1105
Practice Address - Country:US
Practice Address - Phone:973-347-0068
Practice Address - Fax:973-347-6765
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02239600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist