Provider Demographics
NPI:1457393167
Name:VIJAYAKUMAR, CHELLAPPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHELLAPPAN
Middle Name:
Last Name:VIJAYAKUMAR
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 1:517 ROUTE 72 W
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2821
Mailing Address - Country:US
Mailing Address - Phone:609-597-3090
Mailing Address - Fax:609-677-7509
Practice Address - Street 1:517 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2821
Practice Address - Country:US
Practice Address - Phone:609-597-3090
Practice Address - Fax:609-677-7509
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA038064207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8050406Medicaid
NJ189122Medicare ID - Type Unspecified
NJ8050406Medicaid