1285069559 NPI number — ARJUN D. ANEJA, M.D., LLC

Table of content: (NPI 1285069559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285069559 NPI number — ARJUN D. ANEJA, M.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARJUN D. ANEJA, M.D., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1285069559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 CLYDE MORRIS BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ORMOND BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32174-8179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-672-6356
Provider Business Mailing Address Fax Number:
386-672-6366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 CLYDE MORRIS BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-8179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-672-6356
Provider Business Practice Location Address Fax Number:
386-672-6366
Provider Enumeration Date:
09/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ANEJA
Authorized Official First Name:
ARJUN
Authorized Official Middle Name:
DEV
Authorized Official Title or Position:
PHYSICAN
Authorized Official Telephone Number:
386-672-6356

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME66169 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 262303000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27847 . This is a "BCBSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 27847B . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 57596 . This is a "VHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 754916 . This is a "UHC MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2670748 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7688715 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 335095 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10800101 . This is a "CITRUS HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 144681CB . This is a "MVP PREFFERED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195034 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: F931626 . This is a "OPTIMUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010168099 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 174028 . This is a "SUNSHINE STATE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7927305 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00140090 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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