Provider Demographics
NPI:1215085469
Name:JAIN, JASWANT SINGH (MD)
Entity type:Individual
Prefix:
First Name:JASWANT
Middle Name:SINGH
Last Name:JAIN
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 1:118 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-1831
Mailing Address - Country:US
Mailing Address - Phone:585-248-2622
Mailing Address - Fax:
Practice Address - Street 1:118 WEST AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1831
Practice Address - Country:US
Practice Address - Phone:585-381-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155833207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102449BJOtherPREFERRED CARE
NYP010155833OtherBLUE CHOICE
NY1265OtherBCBS
NY16-1252388OtherTAX ID
NY110014592OtherRAILROADMEDICARE
NY16-1252388OtherTAX ID
NY14121BMedicare PIN