Healthcare Provider Details

I. General information

NPI: 1881989671
Provider Name (Legal Business Name): SUDHAKAR J. KHAROD, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 4TH AVE
ASBURY PARK NJ
07712-6009
US

IV. Provider business mailing address

507 4TH AVE
ASBURY PARK NJ
07712-6009
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-5600
  • Fax:
Mailing address:
  • Phone: 732-774-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number25MA03000600
License Number StateNJ

VIII. Authorized Official

Name: DR. SUDHAKAR J. KHAROD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-774-5600