MEDICARE: DR. JOAN OF ARC MARIYAMPILLAI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MA070156	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417916727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN OF ARC MARIYAMPILLAI M.D.

Provider Business Mailing Address
First Line	:	10 FLORENCE PL
Second Line	:
City	:	CALDWELL
State	:	NJ
Zip	:	07006-5608
Country	:	US
Telephone Number	:	862-251-4690
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 BLOOMFIELD AVE
Second Line	:	SUITE LL-1
City	:	VERONA
State	:	NJ
Zip	:	07044-1366
Country	:	US
Telephone Number	:	973-239-3770
Fax Number	:	973-239-3774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	11/08/2023

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