Provider Demographics
NPI:1104111459
Name:JAGADISH V. DAMLE MD, PA
Entity type:Organization
Organization Name:JAGADISH V. DAMLE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAGADISH
Authorized Official - Middle Name:V
Authorized Official - Last Name:DAMLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-420-1715
Mailing Address - Street 1:2 MARINEVIEW PLAZA
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5760
Mailing Address - Country:US
Mailing Address - Phone:201-420-1715
Mailing Address - Fax:201-420-1179
Practice Address - Street 1:2 MARINEVIEW PLAZA
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5760
Practice Address - Country:US
Practice Address - Phone:201-420-1715
Practice Address - Fax:201-420-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3148301Medicaid
NJ3148301Medicaid
DA446219Medicare PIN