Provider Demographics
NPI:1457675159
Name:JADHAV, ASHWIN R (MD, MS)
Entity Type:Individual
Prefix:
First Name:ASHWIN
Middle Name:R
Last Name:JADHAV
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 1ST AVE
Mailing Address - Street 2:NBV 9E2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:718-685-6350
Mailing Address - Fax:212-263-8887
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:NBV 9E2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:718-685-6350
Practice Address - Fax:212-263-8887
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003388207V00000X
NJ25MA09127100207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0312363Medicaid
NJ258410PQ0Medicare PIN
NJ258410A0WMedicare PIN