1275649998 NPI number — AJAY VISWAMBHARAN MD

Table of content: AJAY VISWAMBHARAN MD (NPI 1275649998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275649998 NPI number — AJAY VISWAMBHARAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VISWAMBHARAN
Provider First Name:
AJAY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275649998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 W JIMMIE LEEDS RD
Provider Second Line Business Mailing Address:
SUITE 1100
Provider Business Mailing Address City Name:
GALLOWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08205-9406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-677-9729
Provider Business Mailing Address Fax Number:
609-652-7153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 E MARYLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERS POINT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08244-2451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-677-9729
Provider Business Practice Location Address Fax Number:
609-652-6270
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  25MA07553600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0002704 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00061982 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00758296 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00847752 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com