Provider Demographics
NPI:1497713184
Name:MUTHUSAMY, SAMIAPPAN (MD)
Entity Type:Individual
Prefix:
First Name:SAMIAPPAN
Middle Name:
Last Name:MUTHUSAMY
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 1:695 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9302
Mailing Address - Country:US
Mailing Address - Phone:908-688-6565
Mailing Address - Fax:908-688-3161
Practice Address - Street 1:695 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9302
Practice Address - Country:US
Practice Address - Phone:908-688-6565
Practice Address - Fax:908-688-3161
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35548207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100010883OtherRAILROAD MEDICARE
NJ0K7022OtherHEALTHNET
NJ0780901Medicaid
NJ0033359OtherAETNA
NJP400096OtherOXFORD
NJ0K7022OtherHEALTHNET
NJ0033359OtherAETNA