Provider Demographics
NPI:1225578461
Name:GANGASARRAN, KHILMATTEE (APN)
Entity Type:Individual
Prefix:
First Name:KHILMATTEE
Middle Name:
Last Name:GANGASARRAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 BALDWIN RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-7503
Mailing Address - Country:US
Mailing Address - Phone:973-334-2265
Mailing Address - Fax:
Practice Address - Street 1:239 BALDWIN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-7503
Practice Address - Country:US
Practice Address - Phone:973-334-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00653900363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology