Provider Demographics
NPI:1447204060
Name:RAJAMANICKAM, MALAYANDI (MD)
Entity Type:Individual
Prefix:DR
First Name:MALAYANDI
Middle Name:
Last Name:RAJAMANICKAM
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 1:117 VIA AZURRA
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6908
Mailing Address - Country:US
Mailing Address - Phone:561-743-6928
Mailing Address - Fax:
Practice Address - Street 1:117 VIA AZURRA
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6908
Practice Address - Country:US
Practice Address - Phone:561-743-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA029277207YX0905X
FLME95507207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD90398Medicare UPIN
NJD90398Medicare UPIN