1306402409 NPI number — SWACHI JAIN M.B.B.S

Table of content: SWACHI JAIN M.B.B.S (NPI 1306402409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306402409 NPI number — SWACHI JAIN M.B.B.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAIN
Provider First Name:
SWACHI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.B.B.S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306402409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NORTHWELL HEALTH PATHOLOGY
Provider Second Line Business Mailing Address:
6 - OHIO DRIVE, SUITE 202
Provider Business Mailing Address City Name:
LAKE SUCCESS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-304-7234
Provider Business Mailing Address Fax Number:
516-304-7269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NORTHWELL HEALTH PATHOLOGY
Provider Second Line Business Practice Location Address:
6 - OHIO DRIVE, SUITE 202
Provider Business Practice Location Address City Name:
LAKE SUCCESS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-304-7234
Provider Business Practice Location Address Fax Number:
516-304-7269
Provider Enumeration Date:
05/14/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)