Provider Demographics
NPI:1487749644
Name:KALOLA, AJAY M (LPT)
Entity type:Individual
Prefix:MR
First Name:AJAY
Middle Name:M
Last Name:KALOLA
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14 WOODWARD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3363
Mailing Address - Country:US
Mailing Address - Phone:732-360-1100
Mailing Address - Fax:732-360-1170
Practice Address - Street 1:14 WOODWARD DR
Practice Address - Street 2:SUITE B
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3363
Practice Address - Country:US
Practice Address - Phone:732-360-1100
Practice Address - Fax:732-360-1170
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA006946002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ023574Medicare ID - Type Unspecified