Provider Demographics
NPI:1396151627
Name:MALHOTRA, AJAY
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E 27TH ST
Mailing Address - Street 2:APT 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9275
Mailing Address - Country:US
Mailing Address - Phone:717-994-5279
Mailing Address - Fax:
Practice Address - Street 1:246 N FRANKLIN TPKE
Practice Address - Street 2:SUITE 3B
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1604
Practice Address - Country:US
Practice Address - Phone:201-962-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025761001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice