Provider Demographics
NPI:1578853495
Name:BAJAJ, JAYA
Entity Type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:BAJAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAYA
Other - Middle Name:
Other - Last Name:MAHAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7412 263RD ST
Mailing Address - Street 2:APT 2
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1113
Mailing Address - Country:US
Mailing Address - Phone:516-474-5009
Mailing Address - Fax:
Practice Address - Street 1:7412 263RD ST
Practice Address - Street 2:APT 2
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1113
Practice Address - Country:US
Practice Address - Phone:516-474-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259496207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology