Healthcare Provider Details

I. General information

NPI: 1083694814
Provider Name (Legal Business Name): AJOY PANDEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 14TH AVE
BROOKLYN NY
11228-3307
US

IV. Provider business mailing address

8501 14TH AVE
BROOKLYN NY
11228-3307
US

V. Phone/Fax

Practice location:
  • Phone: 718-256-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number210671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: