Provider Demographics
NPI:1972534782
Name:PAN, JEFF (MD)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2856
Mailing Address - Country:US
Mailing Address - Phone:732-205-9110
Mailing Address - Fax:732-205-9120
Practice Address - Street 1:1101 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2856
Practice Address - Country:US
Practice Address - Phone:732-205-9110
Practice Address - Fax:732-205-9120
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08057100207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH84641Medicare UPIN