Provider Demographics
NPI:1891854030
Name:J&M MARIYAMPILLAI L L C
Entity type:Organization
Organization Name:J&M MARIYAMPILLAI L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCARIOUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARIYAMPILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-239-3770
Mailing Address - Street 1:825 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE LL-1
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1366
Mailing Address - Country:US
Mailing Address - Phone:973-239-3770
Mailing Address - Fax:973-239-3774
Practice Address - Street 1:825 BLOOMFIELD AVE
Practice Address - Street 2:SUITE LL-1
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1366
Practice Address - Country:US
Practice Address - Phone:973-239-3770
Practice Address - Fax:973-239-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8929700Medicaid
NJ044543Medicare PIN