Provider Demographics
NPI:1629183678
Name:DANG, JAGDISH (MD)
Entity Type:Individual
Prefix:
First Name:JAGDISH
Middle Name:
Last Name:DANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 MCBRIDE AVE
Mailing Address - Street 2:STE #D209
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2559
Mailing Address - Country:US
Mailing Address - Phone:973-256-3224
Mailing Address - Fax:973-227-8824
Practice Address - Street 1:1259 ROUTE 46 STE 100
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4913
Practice Address - Country:US
Practice Address - Phone:973-316-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0265722084P0800X
NJ25MA026572002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00279570Medicaid
NJ261921002OtherRAILROAD
NJ1383906Medicaid
NJ181252Medicare ID - Type Unspecified