Provider Demographics
NPI:1487617221
Name:TJOA, MAYLIN M (MD)
Entity type:Individual
Prefix:DR
First Name:MAYLIN
Middle Name:M
Last Name:TJOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 GODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481
Mailing Address - Country:US
Mailing Address - Phone:201-891-7631
Mailing Address - Fax:201-891-0627
Practice Address - Street 1:258 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481
Practice Address - Country:US
Practice Address - Phone:201-891-3336
Practice Address - Fax:201-891-0627
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA57423207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F91304Medicare UPIN
530792M2CMedicare ID - Type Unspecified