Provider Demographics
NPI:1295980969
Name:BHOGAL, JASMEET SINGH (MD)
Entity type:Individual
Prefix:
First Name:JASMEET
Middle Name:SINGH
Last Name:BHOGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7000 ATRIUM WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-291-6818
Mailing Address - Fax:856-291-6819
Practice Address - Street 1:401 YOUNG AVENUE
Practice Address - Street 2:SUITE 180
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2427
Practice Address - Country:US
Practice Address - Phone:856-291-6818
Practice Address - Fax:856-291-6819
Is Sole Proprietor?:No
Enumeration Date:2008-11-23
Last Update Date:2014-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD440059207Q00000X
NJ25MA09414100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0399817Medicaid