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General NPI Number Information
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NPI Number | 1861020182
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Entity Type | Individual
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Provider Name | DR. THARUNJAN KAILAYANATHAN
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 475 SEAVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3436
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Country | US
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Telephone | 973-234-6922
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Fax |
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Provider Business Mailing Address
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Address Line | 95 GAYWOOD AVE
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City | COLONIA
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State | NJ
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Zip | 07067-2044
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Country | US
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Telephone | 973-234-6922
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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 | 25MA12257400
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License Number State | NJ
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