Provider Demographics
NPI:1467508457
Name:CHOLANKERIL MEDICAL ASSOCIATES MD LLC
Entity Type:Organization
Organization Name:CHOLANKERIL MEDICAL ASSOCIATES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOLANKERIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-352-1738
Mailing Address - Street 1:100 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1111
Mailing Address - Country:US
Mailing Address - Phone:908-352-1738
Mailing Address - Fax:908-820-0966
Practice Address - Street 1:100 GROVE ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1111
Practice Address - Country:US
Practice Address - Phone:908-352-1738
Practice Address - Fax:908-820-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA042045207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty