Provider Demographics
NPI:1942257787
Name:AJAY, RAJASREE (MD)
Entity Type:Individual
Prefix:
First Name:RAJASREE
Middle Name:
Last Name:AJAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 W JIMMIE LEEDS RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9438
Mailing Address - Country:US
Mailing Address - Phone:609-748-1001
Mailing Address - Fax:609-748-1002
Practice Address - Street 1:54 W JIMMIE LEEDS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9438
Practice Address - Country:US
Practice Address - Phone:609-748-1001
Practice Address - Fax:609-748-1002
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07573400207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ074334W0JOtherMEDICARE PTAN
NJ0013731Medicaid
NJ2284339000OtherAMERIHEALTH HMO
NJP00665219OtherPALMETTO GBA-RAILROAD MEDICARE
NJP00665219OtherPALMETTO GBA-RAILROAD MEDICARE
NJ074334W0JOtherMEDICARE PTAN
NJP00665219OtherPALMETTO GBA-RAILROAD MEDICARE