Provider Demographics
NPI:1881036291
Name:BAJAJ, JIMMY NERAGE (DO)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:NERAGE
Last Name:BAJAJ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1420
Mailing Address - Country:US
Mailing Address - Phone:516-255-8400
Mailing Address - Fax:
Practice Address - Street 1:196 MERRICK RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1420
Practice Address - Country:US
Practice Address - Phone:516-255-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine