Provider Demographics
NPI:1639196256
Name:ASOKAN, RENGASWAMY (MD)
Entity Type:Individual
Prefix:MR
First Name:RENGASWAMY
Middle Name:
Last Name:ASOKAN
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 1:14 OAK RIDGE RD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07435
Mailing Address - Country:US
Mailing Address - Phone:973-697-3311
Mailing Address - Fax:973-208-8976
Practice Address - Street 1:14 OAK RIDGE RD
Practice Address - Street 2:STE A
Practice Address - City:NEWFOUNDLAND
Practice Address - State:NJ
Practice Address - Zip Code:07435-1450
Practice Address - Country:US
Practice Address - Phone:973-697-3311
Practice Address - Fax:973-208-8976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA043439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D96400Medicare UPIN