Individual
MYTHELY KIRUPAHARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
99 BEAUVOIR AVE, SUMMIT, NJ 07901-3533
(908) 522-6414
(908) 522-0804
Mailing address
PO BOX 416457, BOSTON, MA 02241-6457
(844) 362-1735
(973) 290-7495
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA08960000
NJ
208M00000X
Hospitalist Physician
Primary
25MA08960000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000528882001
BLUE CROSS WNY
NY
05
—
02826488
—
NY
01
—
0414076
IHA
NY
01
—
248279
NYS LICENSE
NY
Enumeration date
09/15/2006
Last updated
03/07/2023
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