Provider Demographics
NPI:1851596613
Name:BAJOR-DATTILO, EWA BEATA (MD)
Entity Type:Individual
Prefix:MS
First Name:EWA
Middle Name:BEATA
Last Name:BAJOR-DATTILO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:EWA
Other - Middle Name:BEATA
Other - Last Name:BAJOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 66689
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-6689
Mailing Address - Country:US
Mailing Address - Phone:866-689-8872
Mailing Address - Fax:
Practice Address - Street 1:94 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5672
Practice Address - Country:US
Practice Address - Phone:866-689-8872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252387-1208VP0000X
NJ25MA09360400207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine