Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | MA61656 | NJ |
N | 207Q00000X | Family Doctor | MA61656 | NJ |
NPI | 1437292752 |
---|---|
Provider Name | Dr. Thayalan Krishna Cumarasamy |
First Address | Burlington, NJ 08016-4718 |
Second Address | Burlington, NJ 08016-4718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2149819 | AETNA (01) | NJ |
6547001 | (05) | NJ |
G03284 | (02) | NJ |