Provider Demographics
NPI:1477758720
Name:SHASTRI, JAY G (DO)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:G
Last Name:SHASTRI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1631
Mailing Address - Country:US
Mailing Address - Phone:609-383-0200
Mailing Address - Fax:609-383-8352
Practice Address - Street 1:510 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1631
Practice Address - Country:US
Practice Address - Phone:609-383-0200
Practice Address - Fax:609-383-8352
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07889100207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0188263Medicaid