Healthcare Provider Details

I. General information

NPI: 1437462835
Provider Name (Legal Business Name): NANDAN THIRUNAHARI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 CHRIS GAUPP
GALLOWAY NJ
08205
US

IV. Provider business mailing address

2500 ENGLISH CREEK AVE. BLDG 200 , STE 211
EGG HARBOR TOWNSHIP NJ
08234
US

V. Phone/Fax

Practice location:
  • Phone: 609-404-9900
  • Fax: 609-404-3653
Mailing address:
  • Phone: 609-677-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA08812400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: