Manickam Ganesh M.D., P.a.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA03057000 Issued in NJ

Legal business name

MANICKAM GANESH M.D., P.A.

Practice address

24 Park Ave
West Orange, NJ 07052-5517

Phone

(973) 669-8181

Fax

(973) 669-1687

NPI assigned

Sep 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Manickam Ganesh, M.D.NPI 1962419838

Title

President

Phone

(973) 669-8181

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Manickam Ganesh, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • West Orange, NJ
  • NPI 1962419838
  Medicare reassignment Care Compare group NPD Authorized official
• Kalyani Theivanayagam, M.D.

  • Internal Medicine Physician
  • Summit, NJ
  • NPI 1598878910
  Medicare reassignment Care Compare group NPD
• Eleftherios Zisis, M.D.

  • Vascular Surgery Physician
  • Essex Fells, NJ
  • NPI 1659384584
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189036800000",
    "number": "1831384486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 ECCLESTON CT",
            "city": "MONTVILLE",
            "state": "NJ",
            "postal_code": "070459663",
            "telephone_number": "973-669-8181",
            "fax_number": "973-669-1687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 PARK AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070525517",
            "telephone_number": "973-669-8181",
            "fax_number": "973-669-1687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANICKAM GANESH M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2007-09-06",
        "status": "A",
        "authorized_official_last_name": "GANESH",
        "authorized_official_first_name": "MANICKAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-669-8181",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA03057000",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA03057000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2957604",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eileen Mangan, MSW
• Kevin C Mange, MD. MSCE
• Manhattan Orthopaedic Spine-NJ
• Manhattan Orthopedic Spine-NJ
• Manheim Family Foot Care LLC
• Andrea C Marana, LCSW
• Nancy Marcel
• Marc Marcelin, DPT
• Julie Lauren Marcelliano, PT
• Marie Sangosse MD PA

• Internal Medicine Physician in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.