Provider Demographics
NPI:1972682797
Name:E SIVALINGAM MD PA
Entity Type:Organization
Organization Name:E SIVALINGAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VARUNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVALINGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-654-1770
Mailing Address - Street 1:103 OLD MARLTON PIKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8772
Mailing Address - Country:US
Mailing Address - Phone:609-654-1770
Mailing Address - Fax:609-654-2320
Practice Address - Street 1:103 OLD MARLTON PIKE
Practice Address - Street 2:SUITE 203
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8772
Practice Address - Country:US
Practice Address - Phone:609-654-1770
Practice Address - Fax:609-654-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06043700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1972682797OtherMEDICARE NPI
NJ=========OtherTAX ID
NJ1972682797OtherMEDICARE NPI
NJ=========OtherTAX ID
NJ034684Medicare PIN