Provider Demographics
NPI:1821420159
Name:JAIN, DEEPALI (MD)
Entity Type:Individual
Prefix:
First Name:DEEPALI
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 1:2245 OCEAN PKWY
Mailing Address - Street 2:3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4849
Mailing Address - Country:US
Mailing Address - Phone:646-415-2023
Mailing Address - Fax:
Practice Address - Street 1:2245 OCEAN PKWY
Practice Address - Street 2:3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4849
Practice Address - Country:US
Practice Address - Phone:646-415-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277073208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics