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General NPI Number Information
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NPI Number | 1245549583
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Entity Type | Organization
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Legal Business Name | GNANA SUNDERAM MD; PC
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 310 CENTRAL AVE STE 205
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City | EAST ORANGE
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State | NJ
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Zip | 07018-2838
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Country | US
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Telephone | 973-266-1227
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Fax |
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Provider Business Mailing Address
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Address Line | 310 CENTRAL AVE STE 205
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City | EAST ORANGE
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State | NJ
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Zip | 07018-2838
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Country | US
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Telephone | 973-266-1227
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GNANA SUNDERAM
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Credential | MD
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Telephone | 973-266-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA04298800
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License Number State | NJ
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