Healthcare Provider Details

I. General information

NPI: 1154902500
Provider Name (Legal Business Name): TEJ AMIT SURA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2163 OAK TREE RD STE 210
EDISON NJ
08820-1083
US

IV. Provider business mailing address

2163 OAK TREE RD STE 210
EDISON NJ
08820-1083
US

V. Phone/Fax

Practice location:
  • Phone: 908-561-9500
  • Fax: 908-561-7162
Mailing address:
  • Phone: 908-561-9500
  • Fax: 908-561-7162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA13233700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: