Healthcare Provider Details

I. General information

NPI: 1336963925
Provider Name (Legal Business Name): VENKATESAN SOUNDERARAJAN APN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JAMES ST
EDISON NJ
08820-3947
US

IV. Provider business mailing address

65 JAMES ST
EDISON NJ
08820-3947
US

V. Phone/Fax

Practice location:
  • Phone: 908-416-0105
  • Fax:
Mailing address:
  • Phone: 908-416-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15203900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: