Provider Demographics
NPI:1003088097
Name:AJAY PAL, DENTIST P.C.
Entity type:Organization
Organization Name:AJAY PAL, DENTIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-753-1355
Mailing Address - Street 1:4281 N HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1018
Mailing Address - Country:US
Mailing Address - Phone:607-753-1355
Mailing Address - Fax:
Practice Address - Street 1:4281 N HOMER AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1018
Practice Address - Country:US
Practice Address - Phone:607-753-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1437176260OtherINDIV. NPI
NY00563942Medicaid