Healthcare Provider Details

I. General information

NPI: 1720312291
Provider Name (Legal Business Name): AJIMASY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 BROADWAY
PATERSON NJ
07514-1422
US

IV. Provider business mailing address

680 BROADWAY
PATERSON NJ
07514-1422
US

V. Phone/Fax

Practice location:
  • Phone: 973-928-2121
  • Fax: 973-928-2126
Mailing address:
  • Phone: 973-928-2121
  • Fax: 973-928-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number28RS00699700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00699700
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMJAD ABUKWAIK
Title or Position: PRESIDENT
Credential:
Phone: 973-928-2121