Provider Demographics
NPI:1689620700
Name:IYENGAR, DEVARAJAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVARAJAN
Middle Name:P
Last Name:IYENGAR
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 1:9 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3424
Mailing Address - Country:US
Mailing Address - Phone:201-858-1211
Mailing Address - Fax:201-858-4171
Practice Address - Street 1:27 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4654
Practice Address - Country:US
Practice Address - Phone:201-858-1211
Practice Address - Fax:201-858-4171
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA38585207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1839802Medicaid
NJC56665Medicare UPIN
NJ520278Medicare ID - Type Unspecified