Provider Demographics
NPI:1083644322
Name:CHOLANKERIL, THRESSIAMMA M (MD)
Entity Type:Individual
Prefix:DR
First Name:THRESSIAMMA
Middle Name:M
Last Name:CHOLANKERIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1111
Mailing Address - Country:US
Mailing Address - Phone:908-352-1738
Mailing Address - Fax:908-820-0966
Practice Address - Street 1:100 GROVE ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1111
Practice Address - Country:US
Practice Address - Phone:908-352-1738
Practice Address - Fax:908-820-0966
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 43326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2021005Medicaid
NJA78972Medicare UPIN
NJ455885Medicare PIN