Provider Demographics
NPI:1285069559
Name:ARJUN D. ANEJA, M.D., LLC
Entity type:Organization
Organization Name:ARJUN D. ANEJA, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:ARJUN
Authorized Official - Middle Name:DEV
Authorized Official - Last Name:ANEJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-672-6356
Mailing Address - Street 1:325 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8179
Mailing Address - Country:US
Mailing Address - Phone:386-672-6356
Mailing Address - Fax:386-672-6366
Practice Address - Street 1:325 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8179
Practice Address - Country:US
Practice Address - Phone:386-672-6356
Practice Address - Fax:386-672-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262303000Medicaid
FL27847OtherBCBSFL
FL27847BOtherMEDICARE
57596OtherVHS
754916OtherUHC MEDICAID
2670748OtherAETNA
7688715OtherGHI PPO
335095OtherAVMED
10800101OtherCITRUS HEALTHCARE
144681CBOtherMVP PREFFERED CARE
195034OtherWELLCARE
F931626OtherOPTIMUM
010168099OtherBLACK LUNG
174028OtherSUNSHINE STATE
7927305OtherAETNA PPO
FLP00140090OtherRAILROAD MEDICARE
57596OtherVHS