Provider Demographics
NPI:1629393772
Name:JAYANTHI PERIASAMY MD PC
Entity Type:Organization
Organization Name:JAYANTHI PERIASAMY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:PERIASAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-563-0033
Mailing Address - Street 1:P O BOX 118
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 DAVIDSON AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-563-0033
Practice Address - Fax:732-563-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA073223002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty