Provider Demographics
NPI:1619669546
Name:KIRAGU, EVELYN W
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:W
Last Name:KIRAGU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 WOODBRIDGE COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-3044
Mailing Address - Country:US
Mailing Address - Phone:732-570-6973
Mailing Address - Fax:
Practice Address - Street 1:1406 WOODBRIDGE COMMONS WAY
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3044
Practice Address - Country:US
Practice Address - Phone:732-570-6973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver