Healthcare Provider Details

I. General information

NPI: 1538576111
Provider Name (Legal Business Name): AMANDEEP SINGH AUJLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 PARKWAY SOUTH
WATERFORD CT
06385
US

IV. Provider business mailing address

1883 LINCOLN AVE
EAST MEADOW NY
11554-2522
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-4455
  • Fax:
Mailing address:
  • Phone: 347-841-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number64850
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: