Provider Demographics
NPI:1104024165
Name:SIVANESAN, SWARNA PRIYA (MD)
Entity type:Individual
Prefix:DR
First Name:SWARNA
Middle Name:PRIYA
Last Name:SIVANESAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-637-9982
Mailing Address - Fax:215-383-0114
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-637-9982
Practice Address - Fax:215-383-0114
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08774100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology