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

Table of Contents

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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