Individual
MANICKAM GANESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24 PARK AVENUE, WEST ORANGE, NJ 07052-5517
(973) 669-8181
(973) 669-1687
Mailing address
5 ECCLESTON COURT, MONTVILLE, NJ 07045-9663
(973) 669-8181
(973) 669-1687
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA03057000
NJ
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
25MA03057000
NJ
207RN0300X
Nephrology Physician
25MA03057000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0603406
—
NJ
Enumeration date
08/02/2006
Last updated
09/11/2025
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