Provider Demographics
NPI:1184038150
Name:BAJAJ, NINA (OD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:BAJAJ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3400
Mailing Address - Country:US
Mailing Address - Phone:973-344-2212
Mailing Address - Fax:973-344-4651
Practice Address - Street 1:279 FERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3400
Practice Address - Country:US
Practice Address - Phone:973-344-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008124152W00000X
NJ27OA00684000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist