MEDICARE: DR. SUBHATHRA KARUNANITHI M.D

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	207Q00000X	Family Medicine Physician	25MA08166100	NJ

General Provider Information

NPI Number	:	1992855258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUBHATHRA KARUNANITHI M.D

Provider Business Mailing Address
First Line	:	41-97 RYS TER
Second Line	:
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-5813
Country	:	US
Telephone Number	:	201-254-9140
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 BERGEN AVE
Second Line	:
City	:	KEARNY
State	:	NJ
Zip	:	07032-3324
Country	:	US
Telephone Number	:	201-998-7474
Fax Number	:	201-998-6550

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	10/09/2012

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