Provider Demographics
NPI:1265830707
Name:ISLAMAJ, ARDIT
Entity Type:Individual
Prefix:MR
First Name:ARDIT
Middle Name:
Last Name:ISLAMAJ
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 1:38 S LENOX ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2522
Mailing Address - Country:US
Mailing Address - Phone:508-340-2129
Mailing Address - Fax:
Practice Address - Street 1:38 S LENOX ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2522
Practice Address - Country:US
Practice Address - Phone:508-340-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS84690575172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver