Healthcare Provider Details

I. General information

NPI: 1003204850
Provider Name (Legal Business Name): MATTHEW GEORGE CHOLANKERIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GROVE ST
ELIZABETH NJ
07202
US

IV. Provider business mailing address

100 GROVE ST
ELIZABETH NJ
07202-1111
US

V. Phone/Fax

Practice location:
  • Phone: 908-352-1738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA10018100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: