Provider Demographics
NPI:1366415465
Name:AGARWALA, AJAY KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:AJAY
Middle Name:KUMAR
Last Name:AGARWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:257-12 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004
Mailing Address - Country:US
Mailing Address - Phone:718-343-3800
Mailing Address - Fax:914-303-5004
Practice Address - Street 1:257-12 UNION TPKE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1252
Practice Address - Country:US
Practice Address - Phone:718-343-3800
Practice Address - Fax:914-303-5004
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA066725207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7554303Medicaid
NJG65759Medicare UPIN
NJ006891Medicare PIN