Provider Demographics
NPI:1710219928
Name:SEETHARAMAN, CHINNASAMY
Entity Type:Individual
Prefix:
First Name:CHINNASAMY
Middle Name:
Last Name:SEETHARAMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 VICTORIAN DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3058
Mailing Address - Country:US
Mailing Address - Phone:732-360-2185
Mailing Address - Fax:
Practice Address - Street 1:49 VICTORIAN DR
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3058
Practice Address - Country:US
Practice Address - Phone:732-360-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist