Provider Demographics
NPI:1942292479
Name:GANAPATHY, JAYALAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYALAKSHMI
Middle Name:
Last Name:GANAPATHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:MUTHUSWAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1706
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-0706
Mailing Address - Country:US
Mailing Address - Phone:201-991-6363
Mailing Address - Fax:201-991-6330
Practice Address - Street 1:8 HEDDEN TER
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6109
Practice Address - Country:US
Practice Address - Phone:201-991-6363
Practice Address - Fax:201-991-6330
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03515300207R00000X, 208D00000X
SDLT1129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00666432OtherRAILROAD MEDICARE
NJ32405OtherUHP NON PAR #
NJ3671003Medicaid
NJ520562TM8Medicare PIN
NJP00666432OtherRAILROAD MEDICARE
NJ32405OtherUHP NON PAR #
NJ3671003Medicaid
NJC56733Medicare UPIN
NJ520562V04Medicare PIN
NJ520562Medicare PIN