Provider Demographics
NPI:1376030114
Name:BAJAJ-MAHAJAN, AMOHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMOHA
Middle Name:
Last Name:BAJAJ-MAHAJAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MADISON AVE RM 806
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5432
Mailing Address - Country:US
Mailing Address - Phone:646-863-4225
Mailing Address - Fax:
Practice Address - Street 1:315 MADISON AVE RM 806
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5432
Practice Address - Country:US
Practice Address - Phone:646-863-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY024801-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty