Provider Demographics
NPI:1053597294
Name:SAJOUS, JAN BERNARD
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:BERNARD
Last Name:SAJOUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 WHITE HORSE RD
Mailing Address - Street 2:SUITE A-102
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2176
Mailing Address - Country:US
Mailing Address - Phone:856-374-4031
Mailing Address - Fax:856-754-6307
Practice Address - Street 1:748 KINGS HWY
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3157
Practice Address - Country:US
Practice Address - Phone:856-848-4998
Practice Address - Fax:856-686-7344
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA085501002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ151850AFMMedicare PIN