Individual
AJAY VISWAMBHARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 E MARYLAND AVE, SOMERS POINT, NJ 08244-2451
(609) 677-9729
(609) 652-6270
Mailing address
72 W JIMMIE LEEDS RD, SUITE 1100, GALLOWAY, NJ 08205-9406
(609) 677-9729
(609) 652-7153
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA07553600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002704
—
NJ
01
—
P00061982
RAILROAD MEDICARE
NJ
01
—
P00758296
RAILROAD MEDICARE
NJ
01
—
P00847752
RAILROAD MEDICARE
NJ
Enumeration date
08/23/2006
Last updated
04/05/2012
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