Healthcare Provider Details

I. General information

NPI: 1366408056
Provider Name (Legal Business Name): HASMUKH SUTARIA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HASMUKH SUTARIA MD PA

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40, UNION AVE SUITE 206
IRVINGTON NJ
07111
US

IV. Provider business mailing address

40, UNION AVE SUITE 206
IRVINGTON NJ
07111
US

V. Phone/Fax

Practice location:
  • Phone: 973-373-1196
  • Fax: 973-373-1197
Mailing address:
  • Phone: 973-373-1196
  • Fax: 973-373-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number47626
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA047626
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: