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General NPI Number Information
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NPI Number | 1417916727
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Entity Type | Individual
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Provider Name | JOAN OF ARC MARIYAMPILLAI M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 825 BLOOMFIELD AVE SUITE LL-1
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City | VERONA
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State | NJ
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Zip | 07044-1366
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Country | US
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Telephone | 973-239-3770
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Fax | 973-239-3774
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Provider Business Mailing Address
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Address Line | 10 FLORENCE PL
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City | CALDWELL
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State | NJ
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Zip | 07006-5608
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Country | US
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Telephone | 862-251-4690
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MA070156
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License Number State | NJ
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