Healthcare Provider Details

I. General information

NPI: 1417101502
Provider Name (Legal Business Name): STEVEN JAMES PORBUNDERWALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2008
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PARK AVE
FLORHAM PARK NJ
07932-1049
US

IV. Provider business mailing address

1 DIAMOND HILL ROAD SUMMIT MEDICAL GROUP
BERKELEY HEIGHTS NJ
07922
US

V. Phone/Fax

Practice location:
  • Phone: 973-404-9980
  • Fax: 973-267-7295
Mailing address:
  • Phone: 908-273-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA09346300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number25MA09346300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: