Provider Demographics
NPI:1477612737
Name:GURUSWAMY, PARVATHI (MD)
Entity Type:Individual
Prefix:
First Name:PARVATHI
Middle Name:
Last Name:GURUSWAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1345
Mailing Address - Country:US
Mailing Address - Phone:201-485-7557
Mailing Address - Fax:201-485-7556
Practice Address - Street 1:810 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1345
Practice Address - Country:US
Practice Address - Phone:201-485-7557
Practice Address - Fax:201-485-7556
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO9148600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101240059OtherBOARD OF MEDICINE
VA010291526Medicaid