Provider Demographics
NPI:1588694780
Name:CHOLANKERIL, MATHEW V (MD)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:V
Last Name:CHOLANKERIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1111
Mailing Address - Country:US
Mailing Address - Phone:908-352-1738
Mailing Address - Fax:908-820-0966
Practice Address - Street 1:100 GROVE ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1111
Practice Address - Country:US
Practice Address - Phone:908-352-1738
Practice Address - Fax:908-820-0966
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42045207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1352903Medicaid
NJ451366Medicare PIN
NJD18946Medicare UPIN