Provider Demographics
NPI:1598938748
Name:K R WIGNARAJAN
Entity Type:Organization
Organization Name:K R WIGNARAJAN
Other - Org Name:K.R. WIGNARAJAN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KANAGARAYER
Authorized Official - Middle Name:RAJAIYAN
Authorized Official - Last Name:WIGNARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-339-1035
Mailing Address - Street 1:875 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2826
Mailing Address - Country:US
Mailing Address - Phone:201-339-1035
Mailing Address - Fax:201-858-3350
Practice Address - Street 1:875 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2826
Practice Address - Country:US
Practice Address - Phone:201-339-1035
Practice Address - Fax:201-858-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02782100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJY50612Medicare UPIN
NJ098504Medicare PIN