Provider Demographics
NPI:1811681315
Name:BAGAVATHY PERUMAL, MEENA PRIYA
Entity type:Individual
Prefix:DR
First Name:MEENA PRIYA
Middle Name:
Last Name:BAGAVATHY PERUMAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 GREEN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2926
Mailing Address - Country:US
Mailing Address - Phone:551-263-5837
Mailing Address - Fax:
Practice Address - Street 1:977 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1843
Practice Address - Country:US
Practice Address - Phone:732-418-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI02985100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program