Provider Demographics
NPI:1619932837
Name:DEVARAJAN, ANANDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANANDAN
Middle Name:
Last Name:DEVARAJAN
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 1:230 W END AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-2153
Mailing Address - Country:US
Mailing Address - Phone:201-437-7619
Mailing Address - Fax:201-437-2419
Practice Address - Street 1:230 W END AVE
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-2153
Practice Address - Country:US
Practice Address - Phone:908-251-5114
Practice Address - Fax:201-437-2419
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07703400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088176Medicare ID - Type Unspecified
NJI25255Medicare UPIN