MEDICARE: DR. JAYALAKSHMI GANAPATHY MD

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	25MA03515300	NJ
2	208D00000X	General Practice Physician	25MA03515300	NJ
3	208000000X	Pediatrics Physician	LT1129	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00666432	OTHER	NJ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	32405	OTHER	NJ	UHP NON PAR #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942292479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYALAKSHMI GANAPATHY MD

Provider Business Mailing Address
First Line	:	PO BOX 1706
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-0706
Country	:	US
Telephone Number	:	201-991-6363
Fax Number	:	201-991-6330

Provider Business Practice Location Address
First Line	:	8 HEDDEN TER
Second Line	:
City	:	NORTH ARLINGTON
State	:	NJ
Zip	:	07031-6109
Country	:	US
Telephone Number	:	201-991-6363
Fax Number	:	201-991-6330

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	04/12/2010

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Directions to “ DR. JAYALAKSHMI GANAPATHY MD” Practice Location

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