Provider Demographics
NPI:1154518181
Name:NANDRA, JASVENDAR SINGH (MD)
Entity type:Individual
Prefix:
First Name:JASVENDAR
Middle Name:SINGH
Last Name:NANDRA
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:PO BOX 95000, LB#7550
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-7550
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:16 OLD BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-3617
Practice Address - Country:US
Practice Address - Phone:973-895-4000
Practice Address - Fax:973-895-3310
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10054400207Q00000X
FL85696207Q00000X
NJ25MA1005440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0569739Medicaid
FLH52143Medicare UPIN
FL85696Medicare PIN