Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 25MA10018100 | NJ |
NPI | 1003204850 |
---|---|
Provider Name | Matthew George Cholankeril |
First Address | Elizabeth, NJ 07202-1111 |
Second Address | Elizabeth, NJ 07202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2015 |
Last Update Date | 14/05/2018 |