Healthcare Provider Details

I. General information

NPI: 1578501128
Provider Name (Legal Business Name): VARUNAN SIVALINGAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 OLD MARLTON PIKE SUITE 203
MEDFORD NJ
08055-8772
US

IV. Provider business mailing address

103 OLD MARLTON PIKE SUITE 203
MEDFORD NJ
08055-8772
US

V. Phone/Fax

Practice location:
  • Phone: 609-657-1770
  • Fax: 609-654-2320
Mailing address:
  • Phone: 609-754-1770
  • Fax: 609-654-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA06043700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: