Provider Demographics
NPI:1326158197
Name:JAAJ, HEDONEIA (MD)
Entity Type:Individual
Prefix:
First Name:HEDONEIA
Middle Name:
Last Name:JAAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 A MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403
Mailing Address - Country:US
Mailing Address - Phone:973-838-0714
Mailing Address - Fax:973-838-7940
Practice Address - Street 1:34 A MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07403
Practice Address - Country:US
Practice Address - Phone:973-838-0714
Practice Address - Fax:973-838-7940
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04235000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3347303Medicaid
NJ3347303Medicaid
C56550Medicare UPIN