Individual
JERISAN JEGANATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
510 HAMBURG TPKE STE 108, WAYNE, NJ 07470-2033
(973) 925-4111
Mailing address
510 HAMBURG TPKE STE 108, WAYNE, NJ 07470-2033
(973) 925-4111
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD00388700
NJ
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/28/2022
Last updated
07/25/2025
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