Provider Demographics
NPI:1336877968
Name:JAIN, DEEPAK (MBBS)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 MIDDLEGREEN CT APT 215
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2093
Mailing Address - Country:US
Mailing Address - Phone:126-780-8753
Mailing Address - Fax:
Practice Address - Street 1:THE MOUNT SINAI HOSPITAL
Practice Address - Street 2:1470 MADISION AVE
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-824-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP115193390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program