Healthcare Provider Details

I. General information

NPI: 1063919686
Provider Name (Legal Business Name): AJAY KUMAR PURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE STE 2
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

1801 NW 9TH AVE STE 700
MIAMI FL
33136-1100
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-1298
  • Fax:
Mailing address:
  • Phone: 305-355-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA12998900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: