Provider Demographics
NPI:1366511123
Name:WINDSOR INTERNAL MEDICINE & GERIATRICS
Entity type:Organization
Organization Name:WINDSOR INTERNAL MEDICINE & GERIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANUSUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEYAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-396-4222
Mailing Address - Street 1:1330 CALHOUN STREET
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638
Mailing Address - Country:US
Mailing Address - Phone:609-396-4222
Mailing Address - Fax:609-396-4378
Practice Address - Street 1:1330 REV S HOWARD WOODSON JR WAY
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-4018
Practice Address - Country:US
Practice Address - Phone:609-396-4222
Practice Address - Fax:609-396-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06324400207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6897401Medicaid
NJ6897401Medicaid
G22021Medicare UPIN