Provider Demographics
NPI:1679583546
Name:JAIN, RATNAM (MD)
Entity Type:Individual
Prefix:
First Name:RATNAM
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FRANKLIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1134
Mailing Address - Country:US
Mailing Address - Phone:973-759-4802
Mailing Address - Fax:973-759-4805
Practice Address - Street 1:14 FRANKLIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1134
Practice Address - Country:US
Practice Address - Phone:973-759-4802
Practice Address - Fax:973-759-4805
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069823207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0101443Medicaid
NJ045404Medicare ID - Type Unspecified