Provider Demographics
NPI:1750508297
Name:AJBANI, KEYUR PRADOBH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEYUR
Middle Name:PRADOBH
Last Name:AJBANI
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:PO BOX 11090
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-1090
Mailing Address - Country:US
Mailing Address - Phone:562-809-3548
Mailing Address - Fax:562-468-0726
Practice Address - Street 1:100 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-9762
Practice Address - Country:US
Practice Address - Phone:724-745-3077
Practice Address - Fax:724-746-8579
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430663207PS0010X
NY244821207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02907413Medicaid
NJMA079138OtherLICENSE
PAMD430663OtherLICENSE
NY5DD5GEE791Medicare PIN