Provider Demographics
NPI:1730112012
Name:KURUNATHAPILLAI, KATHIRGAMATHAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHIRGAMATHAS
Middle Name:
Last Name:KURUNATHAPILLAI
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:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-0425
Mailing Address - Country:US
Mailing Address - Phone:845-901-7487
Mailing Address - Fax:
Practice Address - Street 1:886 BELMONT AVE UNIT C2
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2573
Practice Address - Country:US
Practice Address - Phone:973-333-5857
Practice Address - Fax:201-465-3225
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08812800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0235024Medicaid
NY02878673Medicaid
OH4153182Medicare ID - Type Unspecified