Provider Demographics
NPI:1174182802
Name:GAJADHAR, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GAJADHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3032
Mailing Address - Country:US
Mailing Address - Phone:516-810-0887
Mailing Address - Fax:
Practice Address - Street 1:14 FARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-3032
Practice Address - Country:US
Practice Address - Phone:516-810-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)