Healthcare Provider Details

I. General information

NPI: 1326389792
Provider Name (Legal Business Name): CHANDRIKA C JEYAMOHAN APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 LITTLE ALBANY ST 1124
NEW BRUNSWICK NJ
08901-1914
US

IV. Provider business mailing address

54 VAN DYKE RD
PRINCETON NJ
08540-3642
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-9645
  • Fax: 732-235-3299
Mailing address:
  • Phone: 609-575-3702
  • Fax: 609-651-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00291400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: