Provider Demographics
NPI:1134447493
Name:JASUTKAR, NIREN (MD)
Entity type:Individual
Prefix:
First Name:NIREN
Middle Name:
Last Name:JASUTKAR
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 1:219 N BROAD ST FL 5
Mailing Address - Street 2:DIVISION OF GASTROENTEROLOGY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1507
Mailing Address - Country:US
Mailing Address - Phone:215-762-6072
Mailing Address - Fax:
Practice Address - Street 1:1 MAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1001
Practice Address - Country:US
Practice Address - Phone:551-257-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01844207R00000X
NJ25MA09962100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine