Healthcare Provider Details

I. General information

NPI: 1093252678
Provider Name (Legal Business Name): HARI GNANASEKERAM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 S IRONWOOD DR STE 800W
SOUTH BEND IN
46614-2453
US

IV. Provider business mailing address

2601 BELMAR BLVD STE 800W
BELMAR NJ
07719-4167
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-6000
  • Fax:
Mailing address:
  • Phone: 732-280-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS J CORNEY
Title or Position: MANAGER
Credential:
Phone: 732-280-6000