Individual
CHANDRU JAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., P.C.
Contact information
Practice address
1166 RIVER AVENUE, STE 102, LAKEWOOD, NJ 08701-5035
(732) 364-9565
(732) 364-1908
Mailing address
1166 RIVER AVE, LAKEWOOD, NJ 08701-5600
(732) 364-6004
(732) 364-1908
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA05839100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300090996
RAILROAD
NJ
05
—
5381002
—
NJ
Enumeration date
06/20/2005
Last updated
07/01/2016
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