Individual
DR. DIWAKAR JAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19 BRADHURST AVE, HAWTHORNE, NY 10532-2140
(914) 909-6900
(914) 493-2828
Mailing address
100 WOODS RD, TCC- RM D368, VALHALLA, NY 10595-1530
(914) 493-7530
(914) 493-5827
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
263741
NY
207RC0000X
Cardiovascular Disease Physician
MD072624L
PA
207UN0901X
Nuclear Cardiology Physician
Primary
263741
NY
207UN0901X
Nuclear Cardiology Physician
MD072624L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001829590
—
PA
01
—
263741
NY M.D. LICENSE
NY
Enumeration date
05/05/2006
Last updated
12/01/2021
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