Healthcare Provider Details

I. General information

NPI: 1083665053
Provider Name (Legal Business Name): THANGAMANI SEENIVASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 REHILL AVENUE SUITE 3400
SOMERVILLE NJ
08876-2500
US

IV. Provider business mailing address

30 REHILL AVENUE SUITE 3400
SOMERVILLE NJ
08876-2500
US

V. Phone/Fax

Practice location:
  • Phone: 908-725-2400
  • Fax: 908-927-8990
Mailing address:
  • Phone: 908-725-2400
  • Fax: 908-927-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMAO7549566
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA06938100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: