Provider Demographics
NPI:1669412060
Name:NIJJAR, AJIT SINGH (MD)
Entity type:Individual
Prefix:
First Name:AJIT
Middle Name:SINGH
Last Name:NIJJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0556
Mailing Address - Country:US
Mailing Address - Phone:209-571-6622
Mailing Address - Fax:209-527-2069
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-577-4444
Practice Address - Fax:209-527-2069
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA528042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A528040Medicaid
CA00A528045Medicare PIN
CA00A5280411Medicare PIN
CA00A528049Medicare PIN
CA00A528048Medicare PIN
CA00A528042Medicare PIN
CA00A5280412Medicare PIN
CA00A5280414Medicare PIN
CA00A528047Medicare PIN
CA00A528040Medicaid
CA00A5280413Medicare PIN
CA00A528044Medicare PIN
CAG72703Medicare UPIN
CA00A5280415Medicare PIN
CA00A5280410Medicare PIN
CAP00144702Medicare PIN
CA00A528046Medicare PIN
CA00A528041Medicare PIN