Healthcare Provider Details

I. General information

NPI: 1730275751
Provider Name (Legal Business Name): PUNIDHA SUNDARAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST RD VA HUDSON VALLEY HEALTH CARE SYSTEM
MONTROSE NY
10548
US

IV. Provider business mailing address

50 CENTER ST
RAMSEY NJ
07446-2309
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax:
Mailing address:
  • Phone: 732-977-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number25MA07621400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: