Healthcare Provider Details

I. General information

NPI: 1225667967
Provider Name (Legal Business Name): KANDARP S SUTHAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 VERONICA AVE STE 101
SOMERSET NJ
08873-5002
US

IV. Provider business mailing address

75 VERONICA AVE STE 101
SOMERSET NJ
08873-5002
US

V. Phone/Fax

Practice location:
  • Phone: 732-247-7444
  • Fax: 732-247-5119
Mailing address:
  • Phone: 732-247-7444
  • Fax: 732-247-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MB12692600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: