Provider Demographics
NPI:1891856027
Name:WIGNARAJAN, KANAGARAYER RAJAIYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KANAGARAYER
Middle Name:RAJAIYAN
Last Name:WIGNARAJAN
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 1:875 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2826
Mailing Address - Country:US
Mailing Address - Phone:201-339-1035
Mailing Address - Fax:201-858-3350
Practice Address - Street 1:875 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2826
Practice Address - Country:US
Practice Address - Phone:201-339-1035
Practice Address - Fax:201-858-3350
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ027821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3034909Medicaid
NJE70672Medicare UPIN
NJ3034909Medicaid