Provider Demographics
NPI:1407846173
Name:JAMDAR, NITEEN S (M D)
Entity Type:Individual
Prefix:DR
First Name:NITEEN
Middle Name:S
Last Name:JAMDAR
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:346 SOUTH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1373
Practice Address - Country:US
Practice Address - Phone:908-889-4700
Practice Address - Fax:908-889-0867
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237679207R00000X
NJ25MA07724300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010195969Medicaid
VA008375D10Medicare ID - Type Unspecified
VAI19422Medicare UPIN