Provider Demographics
NPI:1639338627
Name:ALJAJEH, MOUHAB (MD)
Entity Type:Individual
Prefix:MR
First Name:MOUHAB
Middle Name:
Last Name:ALJAJEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:658 MALTA AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020
Mailing Address - Country:US
Mailing Address - Phone:518-580-0553
Mailing Address - Fax:518-580-0557
Practice Address - Street 1:658 MALTA AVE
Practice Address - Street 2:STE 101
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:518-580-0553
Practice Address - Fax:518-580-0557
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070387A207W00000X
NY303835-01207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06292644Medicaid