Provider Demographics
NPI:1629574959
Name:JADAV, PRASHANT JITENDRA (DO)
Entity Type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:JITENDRA
Last Name:JADAV
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 1:111 LIONS CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9353
Mailing Address - Country:US
Mailing Address - Phone:732-543-5551
Mailing Address - Fax:
Practice Address - Street 1:6130 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-6060
Practice Address - Country:US
Practice Address - Phone:775-982-1000
Practice Address - Fax:775-982-5050
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO3006207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine