Provider Demographics
NPI:1689607871
Name:KANUGA, JAYESH GAJENDRABHAI (MD FACAAI, FACA)
Entity Type:Individual
Prefix:DR
First Name:JAYESH
Middle Name:GAJENDRABHAI
Last Name:KANUGA
Suffix:
Gender:M
Credentials:MD FACAAI, FACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1200
Mailing Address - Country:US
Mailing Address - Phone:732-275-9001
Mailing Address - Fax:732-906-1781
Practice Address - Street 1:1740 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2847
Practice Address - Country:US
Practice Address - Phone:732-321-1920
Practice Address - Fax:732-906-1781
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03708800207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1398300Medicaid
NJE87158Medicare UPIN
NJ066542Medicare ID - Type Unspecified