Provider Demographics
NPI:1760708762
Name:GREWAL, JASVINDER KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:JASVINDER
Middle Name:KAUR
Last Name:GREWAL
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 1:27 TANSGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-1508
Mailing Address - Country:US
Mailing Address - Phone:856-768-7164
Mailing Address - Fax:856-768-7164
Practice Address - Street 1:27 TANSGATE BLVD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-1508
Practice Address - Country:US
Practice Address - Phone:856-768-7164
Practice Address - Fax:856-768-7164
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA035865002084P0800X
NJ25MAO3586500208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice