Provider Demographics
NPI:1790749885
Name:GEORGE, AJAX ELIS (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAX
Middle Name:ELIS
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:870 UNITED NATIONS PLZ
Mailing Address - Street 2:23C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1807
Mailing Address - Country:US
Mailing Address - Phone:212-263-5219
Mailing Address - Fax:212-588-8844
Practice Address - Street 1:560 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5219
Practice Address - Fax:212-263-3838
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1047302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00599046Medicaid
NY00599046Medicaid
NYB78789Medicare UPIN