Healthcare Provider Details

I. General information

NPI: 1568513539
Provider Name (Legal Business Name): USHA SUNDARAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W 96TH ST APT 24E
NEW YORK NY
10025-0209
US

IV. Provider business mailing address

275 W 96TH ST APT 24E
NEW YORK NY
10025-0209
US

V. Phone/Fax

Practice location:
  • Phone: 908-391-0496
  • Fax:
Mailing address:
  • Phone: 908-391-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMA028825
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: