Healthcare Provider Details

I. General information

NPI: 1467508457
Provider Name (Legal Business Name): CHOLANKERIL MEDICAL ASSOCIATES MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GROVE ST
ELIZABETH NJ
07202-1111
US

IV. Provider business mailing address

100 GROVE ST
ELIZABETH NJ
07202-1111
US

V. Phone/Fax

Practice location:
  • Phone: 908-352-1738
  • Fax: 908-820-0966
Mailing address:
  • Phone: 908-352-1738
  • Fax: 908-820-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMA042045
License Number StateNJ

VIII. Authorized Official

Name: DR. MATHEW CHOLANKERIL
Title or Position: PARTNER
Credential: MD
Phone: 908-352-1738