Provider Demographics
NPI:1770762015
Name:AHUJA, SANJEEV (MD)
Entity type:Individual
Prefix:
First Name:SANJEEV
Middle Name:
Last Name:AHUJA
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 1:12845 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1223
Mailing Address - Country:US
Mailing Address - Phone:716-937-3255
Mailing Address - Fax:716-204-7481
Practice Address - Street 1:12845 BROADWAY
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1223
Practice Address - Country:US
Practice Address - Phone:716-937-3255
Practice Address - Fax:716-204-7481
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199847207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA9208Medicare PIN
E86535Medicare UPIN
G12763Medicare UPIN