Provider Demographics
NPI:1720162951
Name:BAJWA, MOHAMMAD AYUB (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:AYUB
Last Name:BAJWA
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 1:14 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-429-0601
Mailing Address - Fax:973-429-3305
Practice Address - Street 1:14 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-429-0601
Practice Address - Fax:973-429-3305
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03281800207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2964406Medicaid
D99068Medicare UPIN
NJ2964406Medicaid