Provider Demographics
NPI:1316968381
Name:AJIMI INC
Entity type:Organization
Organization Name:AJIMI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:WEDAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAHOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-772-7600
Mailing Address - Street 1:472 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011
Mailing Address - Country:US
Mailing Address - Phone:973-772-7600
Mailing Address - Fax:973-772-7603
Practice Address - Street 1:472 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-772-7600
Practice Address - Fax:973-772-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00659500333600000X
332BX2000X, 332BP3500X, 335E00000X, 332BC3200X, 332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100528Medicaid
3193529OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NJ0100510OtherMEDICAID DME
3193529OtherOTHER ID NUMBER-COMMERCIAL NUMBER