Provider Demographics
NPI:1972550911
Name:MUNJAL, AJAY K (MD)
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:K
Last Name:MUNJAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18 BROADACRE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1450 E CHESTNUT AVE
Practice Address - Street 2:BUILDING 4, SUITE A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8467
Practice Address - Country:US
Practice Address - Phone:856-794-8664
Practice Address - Fax:856-794-2671
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA557412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8095507Medicaid
NJ1156842OtherHORIZON NJ HEALTH
NH0081121000OtherAMERIHEALTH
NJ300127246OtherRAILROAD MEDICARE
NJ035170Medicare PIN
NH0081121000OtherAMERIHEALTH