Provider Demographics
NPI:1407183783
Name:SAMIR JAIN MD PC
Entity Type:Organization
Organization Name:SAMIR JAIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-608-9737
Mailing Address - Street 1:1588 BEVERLY CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2219
Mailing Address - Country:US
Mailing Address - Phone:732-608-9737
Mailing Address - Fax:732-608-9744
Practice Address - Street 1:599 RTE 37 W
Practice Address - Street 2:SUITE 5
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8011
Practice Address - Country:US
Practice Address - Phone:732-608-9737
Practice Address - Fax:732-608-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-08
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08043800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty