Provider Demographics
NPI:1992709521
Name:AJJAN, GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:AJJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3419
Mailing Address - Country:US
Mailing Address - Phone:201-907-0900
Mailing Address - Fax:201-843-5848
Practice Address - Street 1:870 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3419
Practice Address - Country:US
Practice Address - Phone:201-907-0900
Practice Address - Fax:201-843-5848
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03215900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1913905Medicaid
NJ0109792000OtherAMERIHEALTH #
NJ1042444OtherHORIZON NJ HEALTH #
NJ17385OtherUNIVERSITY HEALTH PLANS
NJ1160885OtherHORIZON NJ HEALTH
NJ2K1110OtherHEALTHNET
NJ160041362OtherRAILROAD MEDICARE
NJ24465OtherAMERICAID AMERIGROUP
NJ1042444OtherHORIZON NJ HEALTH #
NJ24465OtherAMERICAID AMERIGROUP
NJ1913905Medicaid