Provider Demographics
NPI:1821106667
Name:DAMLE, JAGADISH V (MD)
Entity Type:Individual
Prefix:
First Name:JAGADISH
Middle Name:V
Last Name:DAMLE
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 1:384 LONG HILL DR
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1250
Mailing Address - Country:US
Mailing Address - Phone:973-467-3749
Mailing Address - Fax:201-420-1179
Practice Address - Street 1:2 MARINE VIEW PLZ
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5760
Practice Address - Country:US
Practice Address - Phone:201-420-1715
Practice Address - Fax:201-420-1179
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03502200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8812501Medicaid
NJDA446219Medicare ID - Type Unspecified
NJ8812501Medicaid