MEDICARE: DR. PADMA SUNDARAM D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	058757	NY

General Provider Information

NPI Number	:	1225411770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PADMA SUNDARAM D.M.D.

Provider Business Mailing Address
First Line	:	57 BAY ST FL 1
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2510
Country	:	US
Telephone Number	:	844-400-1975
Fax Number	:	845-765-9324

Provider Business Practice Location Address
First Line	:	57 BAY ST FL 1
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2510
Country	:	US
Telephone Number	:	844-400-1975
Fax Number	:	845-765-9324

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	10/31/2023

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Directions to “ DR. PADMA SUNDARAM D.M.D.” Practice Location

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