Provider Demographics
NPI:1912966573
Name:PERIASAMY, JAYANTHI (MD)
Entity Type:Individual
Prefix:
First Name:JAYANTHI
Middle Name:
Last Name:PERIASAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DAVIDSON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1312
Mailing Address - Country:US
Mailing Address - Phone:732-563-0033
Mailing Address - Fax:732-563-0035
Practice Address - Street 1:100 DAVIDSON AVE STE 203
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1312
Practice Address - Country:US
Practice Address - Phone:732-563-0033
Practice Address - Fax:732-563-0035
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA073223002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry