Provider Demographics
NPI:1780651497
Name:KIRTANE, AJAY J (MD, SM)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:J
Last Name:KIRTANE
Suffix:
Gender:M
Credentials:MD, SM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FORT WASHINGTON AVE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-7060
Mailing Address - Fax:212-342-3680
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-7060
Practice Address - Fax:212-342-3680
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71805207R00000X
MA217031207R00000X
NY240955207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH41033Medicare UPIN
CAH41033Medicare UPIN