Provider Demographics
NPI:1023218633
Name:PERUMAL, GANESHA G (MS SLP-CCC)
Entity Type:Individual
Prefix:MR
First Name:GANESHA
Middle Name:G
Last Name:PERUMAL
Suffix:
Gender:M
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 PEBBLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1945
Mailing Address - Country:US
Mailing Address - Phone:609-737-1345
Mailing Address - Fax:
Practice Address - Street 1:412 PEBBLE CREEK CT
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1945
Practice Address - Country:US
Practice Address - Phone:609-737-1345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-21
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00349400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist