Healthcare Provider Details

I. General information

NPI: 1508803909
Provider Name (Legal Business Name): BHANU K SUNKU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 ESSEX ST SUITE 402
HACKENSACK NJ
07601-8550
US

IV. Provider business mailing address

360 ESSEX ST SUITE 402
HACKENSACK NJ
07601-8550
US

V. Phone/Fax

Practice location:
  • Phone: 201-336-8840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number25MA07778000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: