# MANICKAM GANESH M.D., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831384486
- **Authorized official:** DR. MANICKAM GANESH M.D. (PRESIDENT)
- **Authorized official phone:** (973) 669-8181

## Contact information

- **Practice address:** 24 PARK AVE, WEST ORANGE, NJ 07052-5517
- **Practice address phone:** (973) 669-8181
- **Practice address fax:** (973) 669-1687
- **Mailing address:** 5 ECCLESTON CT, MONTVILLE, NJ 07045-9663
- **Mailing address phone:** (973) 669-8181
- **Mailing address fax:** (973) 669-1687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 25MA03057000 | NJ | Yes |
| 207RN0300X | Nephrology Physician | 25MA03057000 | NJ | — |

## Other

- **Enumeration date:** 09/06/2007
- **Last updated:** 09/06/2007