MEDICARE: DR. KOMAL BAJAJ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0000X	Obstetrics Physician	248090	NY
2	207V00000X	Obstetrics & Gynecology Physician	036118200	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	248090	OTHER	NY	NYS MEDICAL LICENSE

General Provider Information

NPI Number	:	1205009628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KOMAL BAJAJ MD

Provider Business Mailing Address
First Line	:	1400 PELHAM PKWY S
Second Line	:	1BS16
City	:	BRONX
State	:	NY
Zip	:	10461-1138
Country	:	US
Telephone Number	:	630-728-9524
Fax Number	:	718-918-6318

Provider Business Practice Location Address
First Line	:	1400 PELHAM PKWY S # 1BS16
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1119
Country	:	US
Telephone Number	:	718-918-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2008
Last Update Date	:	03/12/2019

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