Provider Demographics
NPI:1538159405
Name:GOEL, AJAY (MD)
Entity type:Individual
Prefix:DR
First Name:AJAY
Middle Name:
Last Name:GOEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 PERIMETER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-4018
Mailing Address - Country:US
Mailing Address - Phone:315-337-0539
Mailing Address - Fax:315-337-0645
Practice Address - Street 1:91 PERIMETER RD STE 120
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4018
Practice Address - Country:US
Practice Address - Phone:315-337-0539
Practice Address - Fax:315-337-0645
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1630511207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100016994OtherRR MEDICARE
10060788OtherCDPHP
105078OtherMVP
9610144OtherGHI
000008462OtherEXCELLUS
01127522OtherMEDICAID
040426013748OtherFIDELIS
100016994OtherRR MEDICARE
9610144OtherGHI