Ganesh, Manickam
Ganesh, Manickam is an individual health care provider with primary practice located at 24 Park Avenue , West Orange NJ 07052-5517. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Nephrology. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Ganesh, Manickam can be contacted via phone (973) 669-8181.Contact Information
Primary practice address
24 Park Avenue
West Orange NJ 07052-5517
Phone: (973) 669-8181
Fax: (973) 669-1687
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 25MA03057000 | New Jersey |
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | 25MA03057000 | New Jersey |
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | 25MA03057000 | New Jersey |
Profile Details
| NPI number | 1962419838 |
|---|---|
| LBN Legal business name | Ganesh, Manickam |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 2nd, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962419838 | NPPES |
| New Jersey | MEDICAID | 0603406 |
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