Provider Demographics
NPI:1427014224
Name:ANANDARANGAM, THIRUVENGADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:THIRUVENGADAM
Middle Name:
Last Name:ANANDARANGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LYONS AVENUE
Mailing Address - Street 2:SUITE D3
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2026
Mailing Address - Country:US
Mailing Address - Phone:973-926-6347
Mailing Address - Fax:973-923-5688
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:D3
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-6347
Practice Address - Fax:973-923-5688
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62820207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6736505Medicaid
NJG19740Medicare UPIN
NJ204363Medicare PIN