Provider Demographics
NPI:1003882663
Name:KHANTHAN, SUBRAMANIUM E (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBRAMANIUM
Middle Name:E
Last Name:KHANTHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3682
Mailing Address - Country:US
Mailing Address - Phone:201-653-9561
Mailing Address - Fax:
Practice Address - Street 1:3049 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3682
Practice Address - Country:US
Practice Address - Phone:201-653-9561
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02732900207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6429700Medicaid
NJ6429700Medicaid
NJ475478Medicare ID - Type Unspecified