MEDICARE: J&M MARIYAMPILLAI L L C

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

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	:	1891854030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J&M MARIYAMPILLAI L L C

Provider Business Mailing 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

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	:	PARTNER
Name	:	DR. MARCARIOUS A MARIYAMPILLAI
Credential	:	M.D.
Telephone Number	:	973-239-3770

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/25/2008

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