Basic Information
| Provider Information | |||||||||
| NPI: | 1053842310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMJA | ||||||||
| FirstName: | JACQUES | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 E NORWEGIAN ST | ||||||||
| Address2: | |||||||||
| City: | POTTSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179012710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706214000 | ||||||||
| FaxNumber: | 5706225493 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 E NORWEGIAN ST | ||||||||
| Address2: | |||||||||
| City: | POTTSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179012710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706214000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2017 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD472011 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.