Provider Demographics
NPI:1477573814
Name:WALIA, JASJIT (MD)
Entity Type:Individual
Prefix:
First Name:JASJIT
Middle Name:
Last Name:WALIA
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 1:1150 DICKINSON ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2210
Mailing Address - Country:US
Mailing Address - Phone:908-354-8900
Mailing Address - Fax:908-354-0007
Practice Address - Street 1:1150 DICKINSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2210
Practice Address - Country:US
Practice Address - Phone:908-354-8900
Practice Address - Fax:908-354-0007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065019207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8506108Medicaid
NJ8506108Medicaid
NJ047969Medicare ID - Type Unspecified