Healthcare Provider Details

I. General information

NPI: 1841247186
Provider Name (Legal Business Name): UMA SUNDARAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 ROUTE 88 W SUITE B
BRICK NJ
08724-2373
US

IV. Provider business mailing address

2101 FRIAR CT
WALL TOWNSHIP NJ
07719-9744
US

V. Phone/Fax

Practice location:
  • Phone: 732-458-5000
  • Fax: 732-458-6265
Mailing address:
  • Phone: 732-974-2834
  • Fax: 732-974-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA04994700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA04994700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: