Provider Demographics
NPI:1245485895
Name:AHLAWAT, SANJAY
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:AHLAWAT
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SANJAY
Other - Middle Name:
Other - Last Name:AHLAWAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9 ASPEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1201
Mailing Address - Country:US
Mailing Address - Phone:862-216-4879
Mailing Address - Fax:
Practice Address - Street 1:42 THROCKMORTON LN
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2572
Practice Address - Country:US
Practice Address - Phone:732-607-1111
Practice Address - Fax:732-607-0552
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00663700363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty