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General NPI Number Information
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NPI Number | 1851599005
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Entity Type | Organization
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Legal Business Name | JON R SUNDELL DPM PC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 7355 AMBOY RD
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City | STATEN ISLAND
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State | NY
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Zip | 10307-1426
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Country | US
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Telephone | 917-207-9076
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Fax |
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Provider Business Mailing Address
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Address Line | 7355 AMBOY RD
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City | STATEN ISLAND
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State | NY
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Zip | 10307-1426
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Country | US
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Telephone | 917-207-9076
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JON R SUNDELL
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Credential | DPM
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Telephone | 917-207-9076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N005463
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License Number State | NY
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