Basic Information
| Provider Information | |||||||||
| NPI: | 1740607969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANNEERSELVAM | ||||||||
| FirstName: | NARMADHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 725 | ||||||||
| Address2: | |||||||||
| City: | COOPERSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133260725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075473456 | ||||||||
| FaxNumber: | 6075476612 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BRANCH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077406303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322225200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 25MA10173100 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.