Provider Demographics
NPI:1518912146
Name:AJIT K KHANUJA MD
Entity Type:Organization
Organization Name:AJIT K KHANUJA MD
Other - Org Name:MEDICAL DIAGNOSTIC ULTRASOUND AND MAMMOGRAPHY
Other - Org Type:Other Name
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHANUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-272-1212
Mailing Address - Street 1:1444 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1600
Mailing Address - Country:US
Mailing Address - Phone:518-272-1212
Mailing Address - Fax:518-272-9228
Practice Address - Street 1:1444 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1600
Practice Address - Country:US
Practice Address - Phone:518-272-1212
Practice Address - Fax:518-272-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11519112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50309BMedicare ID - Type Unspecified