Healthcare Provider Details

I. General information

NPI: 1871789628
Provider Name (Legal Business Name): C. E. PASUPATHY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 COLLEGE DR SUITE 1B
VINELAND NJ
08360-6933
US

IV. Provider business mailing address

2950 COLLEGE DR SUITE 1B
VINELAND NJ
08360-6933
US

V. Phone/Fax

Practice location:
  • Phone: 856-691-7588
  • Fax: 856-691-0433
Mailing address:
  • Phone: 856-691-7588
  • Fax: 856-691-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA03258300
License Number StateNJ

VIII. Authorized Official

Name: BETTY J GANDY
Title or Position: BILLING MANAGER
Credential:
Phone: 856-451-9395