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General NPI Number Information
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NPI Number | 1366453409
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Entity Type | Individual
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Provider Name | SUSHIL K MEHANDRU MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 1925 HWY 35 W
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City | WALL
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State | NJ
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Zip | 07719
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Country | US
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Telephone | 732-974-0100
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Fax | 732-974-0137
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Provider Business Mailing Address
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Address Line | 1925 HWY 35
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City | WALL
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State | NJ
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Zip | 07719
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Country | US
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Telephone | 732-974-0100
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Fax | 732-974-0137
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MA034596
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License Number State | NJ
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