Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | ME95507 | FL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MA029277 | NJ |
NPI | 1447204060 |
---|---|
Provider Name | Dr. Malayandi Rajamanickam |
First Address | Jupiter, FL 33458-6908 |
Second Address | Jupiter, FL 33458-6908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 04/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D90398 | (02) | NJ |