Provider Demographics
NPI:1417928789
Name:GAJIAN, GAREN (MD)
Entity Type:Individual
Prefix:
First Name:GAREN
Middle Name:
Last Name:GAJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 POWERS ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3028
Mailing Address - Country:US
Mailing Address - Phone:732-745-2989
Mailing Address - Fax:
Practice Address - Street 1:251 POWERS ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3028
Practice Address - Country:US
Practice Address - Phone:732-745-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ06954900207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0003808Medicaid
NJ0003808Medicaid
NJ030294Medicare PIN