Provider Demographics
NPI:1487633400
Name:ROY, AJOY KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AJOY
Middle Name:KUMAR
Last Name:ROY
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 1:110 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2507
Mailing Address - Country:US
Mailing Address - Phone:315-349-5511
Mailing Address - Fax:315-349-5921
Practice Address - Street 1:105 COUNTY ROUTE 45A
Practice Address - Street 2:SUITE 400
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6664
Practice Address - Country:US
Practice Address - Phone:315-312-0089
Practice Address - Fax:315-312-0110
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00712116Medicaid
NYB82166Medicare UPIN
NY00712116Medicaid