Provider Demographics
NPI:1386060507
Name:JARIWALA, PUNIT RAJNIKANT (MD)
Entity type:Individual
Prefix:
First Name:PUNIT
Middle Name:RAJNIKANT
Last Name:JARIWALA
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 1:100 HWY 36
Mailing Address - Street 2:SUITE 2K
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1462
Mailing Address - Country:US
Mailing Address - Phone:732-531-6600
Mailing Address - Fax:732-531-6606
Practice Address - Street 1:100 HWY 36
Practice Address - Street 2:SUITE 2K
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1462
Practice Address - Country:US
Practice Address - Phone:732-531-6600
Practice Address - Fax:732-531-6606
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09440300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine