Healthcare Provider Details

I. General information

NPI: 1033739859
Provider Name (Legal Business Name): SUMITHA UDAYASHANKAR TARUR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LENOX AVENUE DEPARTMENT OF PEDIATRICS: MLK 17-110
NEW YORK NY
10037-1802
US

IV. Provider business mailing address

506 LENOX AVENUE DEPARTMENT OF PEDIATRICS: MLK 17-110
NEW YORK NY
10037-1802
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-4019
  • Fax: 212-939-4022
Mailing address:
  • Phone: 212-939-4019
  • Fax: 212-939-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: