Provider Demographics
NPI:1922196815
Name:GOYAL, AJAY (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:GOYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:193 MORRIS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1211
Mailing Address - Country:US
Mailing Address - Phone:908-481-1270
Mailing Address - Fax:908-688-8861
Practice Address - Street 1:193 MORRIS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1211
Practice Address - Country:US
Practice Address - Phone:908-481-1270
Practice Address - Fax:908-688-8861
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07495000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072011BKEMedicare UPIN