Provider Demographics
NPI:1912699851
Name:HAJDARMATAJ, EGLI (DMD, DDS)
Entity Type:Individual
Prefix:DR
First Name:EGLI
Middle Name:
Last Name:HAJDARMATAJ
Suffix:
Gender:M
Credentials:DMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1376 MERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6024
Mailing Address - Country:US
Mailing Address - Phone:929-369-4615
Mailing Address - Fax:
Practice Address - Street 1:1376 MERRY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6024
Practice Address - Country:US
Practice Address - Phone:929-369-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02970900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist