NPIMap

Individual provider Active NPI

Manickam Ganesh, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • West Orange, NJ
National Provider Identifier
1962419838
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
25MA03057000 Issued in NJ
Practice address
24 Park Avenue
West Orange, NJ 07052-5517
Phone
(973) 669-8181
Fax
(973) 669-1687
NPI assigned
Aug 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA03057000 NJ
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 25MA03057000 NJ Primary
Nephrology Physician 207RN0300X 25MA03057000 NJ

Addresses

Primary practice location

24 Park Avenue
West Orange, NJ 07052-5517

Mailing address

5 Eccleston Court
Montville, NJ 07045-9663
Phone (973) 669-8181

Other identifiers 1

IdentifierTypeStateIssuer
0603406MedicaidNJ

Other names 1

  • Manickam Ganesh Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101208000355 NJ Practitioner - Internal MedicinePractitioner - Nephrology 6608062963 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Nephrology
Education
Other, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Manickam Ganesh MD PAGroup PAC ID 8921053224, 2 clinicians

Practice addresses (Care Compare)

24 Park Ave
West Orange, NJ 07052-5553
Phone (973) 669-8181

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA03057000NJMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Manickam Ganesh M.D., P.a. Internal Medicine CurrentSince Nov 30, 1979 Accepting new patients
Cooperman Barnabas Medical Center Inc Past Accepting new patients

Locations

94 Old Short Hills Rd
Livingston, NJ 07039
Phone (973) 322-5400

24 Park Ave
West Orange, NJ 07052
Phone (973) 669-0878

24 Park Ave
Fl 1
West Orange, NJ 07052

Interoperability endpoints

  • Direct secure messaging: mganesh238902@epicdirect.rwjbh.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1962419838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 ECCLESTON COURT",
            "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 AVENUE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070525517",
            "telephone_number": "973-669-8181",
            "fax_number": "973-669-1687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANESH",
        "first_name": "MANICKAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA03057000",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MA03057000",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NJ",
            "license": "25MA03057000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0603406",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANICKAM",
            "last_name": "GANESH",
            "credential": "MD, PA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in West Orange, NJ

Sources for this page

Verify at the official NPI Registry.