Provider Demographics
NPI:1437244464
Name:AJAY GOEL PHYSICIAN PC
Entity Type:Organization
Organization Name:AJAY GOEL PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-337-0539
Mailing Address - Street 1:91 PERIMETER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-4018
Mailing Address - Country:US
Mailing Address - Phone:315-725-8653
Mailing Address - Fax:315-337-0645
Practice Address - Street 1:91 PERIMETER RD STE 120
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4018
Practice Address - Country:US
Practice Address - Phone:315-337-0539
Practice Address - Fax:315-337-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538159405OtherNPI GOEL
NYDD3309Medicare PIN
NYPA2088Medicare PIN
1538159405OtherNPI GOEL