Provider Demographics
NPI:1407984008
Name:JYOTHIRMAYI, GARIKIPARTHY NAGA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GARIKIPARTHY
Middle Name:NAGA
Last Name:JYOTHIRMAYI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5604
Mailing Address - Country:US
Mailing Address - Phone:973-535-8870
Mailing Address - Fax:973-535-8818
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE # 201
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-535-8870
Practice Address - Fax:973-535-8818
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00166200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MP00166200OtherNJ LICENSE