Healthcare Provider Details

I. General information

NPI: 1689620700
Provider Name (Legal Business Name): DEVARAJAN P. IYENGAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E 29TH ST
BAYONNE NJ
07002-4654
US

IV. Provider business mailing address

9 CHELSEA DR
LIVINGSTON NJ
07039-3424
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-1211
  • Fax: 201-858-4171
Mailing address:
  • Phone: 201-858-1211
  • Fax: 201-858-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMA38585
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: