Healthcare Provider Details

I. General information

NPI: 1093786212
Provider Name (Legal Business Name): SHAILENDRA HAJELA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NEWARK AVE 15 NEWARK AVE
BELLEVILLE NJ
07109-1123
US

IV. Provider business mailing address

15 NEWARK AVE JERSEY REHAB PA
BELLEVILLE NJ
07109-1123
US

V. Phone/Fax

Practice location:
  • Phone: 973-844-9220
  • Fax: 973-844-9221
Mailing address:
  • Phone: 973-844-9220
  • Fax: 973-844-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA08207900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number258165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: