Provider Demographics
NPI:1598068090
Name:MOHAMMAD AYUB BAJWA M.D., P. A.
Entity Type:Organization
Organization Name:MOHAMMAD AYUB BAJWA M.D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:AYUB
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-429-0601
Mailing Address - Street 1:14 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-429-0601
Mailing Address - Fax:
Practice Address - Street 1:14 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-429-0601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03281800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
460356OtherMEDICARE
NJ2964406Medicaid
460356OtherMEDICARE