Provider Demographics
NPI:1558452946
Name:JEGANATHAN, NARAYANAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NARAYANAN
Middle Name:
Last Name:JEGANATHAN
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 1:1140 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3623
Mailing Address - Country:US
Mailing Address - Phone:732-246-4699
Mailing Address - Fax:732-246-4889
Practice Address - Street 1:1140 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3623
Practice Address - Country:US
Practice Address - Phone:732-246-4699
Practice Address - Fax:732-246-4889
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41247207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5129800Medicaid
E56811Medicare UPIN
NJJE448228H5PMedicare ID - Type Unspecified