| Manickam Ganesh M.d., P.a. | |
|
24 Park Ave West Orange NJ 07052-5517 | |
| (973) 669-8181 | |
| (973) 669-1687 |
| Full Name | Manickam Ganesh M.d., P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 24 Park Ave, West Orange, New Jersey |
| Authorized Official Name and Position | Manickam Ganesh (PRESIDENT) |
| Authorized Official Contact | 9736698181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manickam Ganesh M.d., P.a. 5 Eccleston Ct Montville NJ 07045-9663 Ph: (973) 669-8181 | Manickam Ganesh M.d., P.a. 24 Park Ave West Orange NJ 07052-5517 Ph: (973) 669-8181 |
| NPI Number | 1831384486 |
|---|---|
| Provider Enumeration Date | 09/06/2007 |
| Last Update Date | 09/06/2007 |
| Medicare PECOS PAC ID | 8921053224 |
|---|---|
| Medicare Enrollment ID | O20050321000190 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831384486 | NPI | - | NPPES |
| 2957604 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MA03057000 (New Jersey) | Primary |
| 207RN0300X | Internal Medicine - Nephrology | 25MA03057000 (New Jersey) | Secondary |
| Provider Name | Manickam Ganesh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962419838 PECOS PAC ID: 6608062963 Enrollment ID: I20101208000355 |
| Provider Name | Kalyani Theivanayagam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598878910 PECOS PAC ID: 1052507316 Enrollment ID: I20101222000753 |
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