MEDICARE: DR. MANGAIYARKKARASI SIVAKUMAR MD MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	25MA10945300	NJ

General Provider Information

NPI Number	:	1942725049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANGAIYARKKARASI SIVAKUMAR MD MS

Provider Business Mailing Address
First Line	:	485 GEORGES RD STE 114
Second Line	:
City	:	DAYTON
State	:	NJ
Zip	:	08810-2439
Country	:	US
Telephone Number	:	888-460-1151
Fax Number	:

Provider Business Practice Location Address
First Line	:	485 GEORGES RD STE 114
Second Line	:
City	:	DAYTON
State	:	NJ
Zip	:	08810-2439
Country	:	US
Telephone Number	:	888-460-1151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	10/05/2023

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