1558353763 NPI number — AJAY JAIN MD

Table of content: AJAY JAIN MD (NPI 1558353763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558353763 NPI number — AJAY JAIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAIN
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:
1558353763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65-11 BOOTH STREET
Provider Second Line Business Mailing Address:
SUITE 1C
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374-4184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-806-1434
Provider Business Mailing Address Fax Number:
718-806-1435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65-11 BOOTH STREET
Provider Second Line Business Practice Location Address:
SUITE 1C
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374-4184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-806-1434
Provider Business Practice Location Address Fax Number:
718-806-1435
Provider Enumeration Date:
08/16/2005

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: 207R00000X , with the licence number:  238516 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00215186 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com