Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MT223173 | PA |
Y | 111NI0900X | Internist | MT223173 | PA |
NPI | 1003487059 |
---|---|
Provider Name | Ashish Jain |
First Address | Johnstown, PA 15905-4305 |
Second Address | Johnstown, PA 15905-4305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2021 |
Last Update Date | 09/07/2021 |