Provider Demographics
NPI:1205368149
Name:GANESAN, SRIRANJANI
Entity Type:Individual
Prefix:
First Name:SRIRANJANI
Middle Name:
Last Name:GANESAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 TEA ST
Mailing Address - Street 2:APT 3304
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1189
Mailing Address - Country:US
Mailing Address - Phone:972-697-1563
Mailing Address - Fax:
Practice Address - Street 1:675 TEA ST
Practice Address - Street 2:APT 3304
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1189
Practice Address - Country:US
Practice Address - Phone:972-697-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00701000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist