Provider Demographics
NPI:1770683245
Name:JAIN, AJAY (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:550 HARRISON ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3188
Mailing Address - Country:US
Mailing Address - Phone:315-464-1800
Mailing Address - Fax:315-464-6252
Practice Address - Street 1:550 HARRISON ST
Practice Address - Street 2:SUITE 330
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3188
Practice Address - Country:US
Practice Address - Phone:315-464-1800
Practice Address - Fax:315-464-6252
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY272673208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03757531Medicaid
NY03757531Medicaid