Provider Demographics
NPI:1851477475
Name:AGARWAL, JAI B (MD)
Entity Type:Individual
Prefix:
First Name:JAI
Middle Name:B
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JIMMY CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7100
Mailing Address - Country:US
Mailing Address - Phone:732-846-0928
Mailing Address - Fax:732-846-0928
Practice Address - Street 1:1 JIMMY CT
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-7100
Practice Address - Country:US
Practice Address - Phone:732-846-0928
Practice Address - Fax:732-846-0928
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA52985174400000X
NJ25MA05298500207RC0000X
NJMA052985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0420701Medicaid
NJ780222259OtherHORIZON
NJP522059OtherOXFORD
NJ1093650OtherHORIZON NJ HEALTH
NJ53542OtherAETNA
NJ060015487OtherRR MCR PTAN
NJ109108OtherAMERIHEALTH
NJF04677OtherHEALTHNET
NJMI000005200OtherAMERICHOICE
NJ10442OtherUNIVERSITY HEALTH PLANS
NJ123565OtherONE HEALTH PLAN OF NJ
NJ0359380006OtherCIGNA
NJ0359380006OtherCIGNA
NJ780222259OtherHORIZON
NJ123565OtherONE HEALTH PLAN OF NJ