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General NPI Number Information
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NPI Number | 1760682173
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Entity Type | Individual
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Provider Name | SUSHAMA MODY M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 714 10TH ST
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City | SECAUCUS
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State | NJ
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Zip | 07094-2921
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Country | US
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Telephone | 551-257-7038
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Fax |
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Provider Business Mailing Address
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Address Line | 38 MEADOWLANDS PKWY
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City | SECAUCUS
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State | NJ
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Zip | 07094-2925
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Country | US
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Telephone | 551-257-7038
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Fax |
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 25MA08633800
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License Number State | NJ
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