Individual
KALYANI THEIVANAYAGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
276 WOODLAND AVE, SUMMIT, NJ 07901-1437
(973) 669-8181
(973) 669-1687
Mailing address
276 WOODLAND AVE, SUMMIT, NJ 07901-1437
(973) 669-8181
(973) 669-1687
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA06857500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7878109
—
NJ
Enumeration date
08/17/2006
Last updated
12/23/2010
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