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Organization
MANICKAM GANESH M.D., P.A.
Active
Organization
MANICKAM GANESH M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANICKAM GANESH M.D. (PRESIDENT)
(973) 669-8181
Entity
Organization
Contact information
Practice address
24 PARK AVE, WEST ORANGE, NJ 07052-5517
(973) 669-8181
(973) 669-1687
Mailing address
5 ECCLESTON CT, MONTVILLE, NJ 07045-9663
(973) 669-8181
(973) 669-1687
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA03057000
NJ
207RN0300X
Nephrology Physician
25MA03057000
NJ
Other
Enumeration date
09/06/2007
Last updated
09/06/2007
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