Healthcare Provider Details

I. General information

NPI: 1942725049
Provider Name (Legal Business Name): MANGAIYARKKARASI SIVAKUMAR MD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 GEORGES RD STE 114
DAYTON NJ
08810-2439
US

IV. Provider business mailing address

485 GEORGES RD STE 114
DAYTON NJ
08810-2439
US

V. Phone/Fax

Practice location:
  • Phone: 888-460-1151
  • Fax:
Mailing address:
  • Phone: 888-460-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA10945300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: