Provider Demographics
NPI:1023243623
Name:JETLEY, AJAY V (MD)
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:V
Last Name:JETLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:46 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2125
Mailing Address - Country:US
Mailing Address - Phone:201-399-7695
Mailing Address - Fax:201-399-7697
Practice Address - Street 1:35 ACKERMAN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1501
Practice Address - Country:US
Practice Address - Phone:973-928-2880
Practice Address - Fax:973-928-2881
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2021-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35096587207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09223700OtherMEDICAL LICENSE