Provider Demographics
NPI:1851312656
Name:JAIN, SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1588 BEVERLY CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2219
Mailing Address - Country:US
Mailing Address - Phone:732-608-9737
Mailing Address - Fax:732-608-9744
Practice Address - Street 1:599 RTE 37 W
Practice Address - Street 2:SUITE 5
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8011
Practice Address - Country:US
Practice Address - Phone:732-608-9737
Practice Address - Fax:732-608-9744
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08048300207R00000X
NJ25MA08043800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease