Provider Demographics
NPI:1053808535
Name:GREWAL, JASKARAN (MD)
Entity type:Individual
Prefix:DR
First Name:JASKARAN
Middle Name:
Last Name:GREWAL
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 1:433 RIVER RD APT 1219
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1941
Mailing Address - Country:US
Mailing Address - Phone:661-645-1278
Mailing Address - Fax:
Practice Address - Street 1:385 5TH AVE RM 1106
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3340
Practice Address - Country:US
Practice Address - Phone:917-391-0076
Practice Address - Fax:917-477-8649
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1828432084P0800X
390200000X
NY315034-012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program