MEDICARE: DAVID C SUNDSTROM MD

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	207T00000X	Neurological Surgery Physician	25MA05465900	NJ

General Provider Information

NPI Number	:	1346246832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID C SUNDSTROM MD

Provider Business Mailing Address
First Line	:	1680 ROUTE 23
Second Line	:	SUITE 250
City	:	WAYNE
State	:	NJ
Zip	:	07470-7501
Country	:	US
Telephone Number	:	973-633-1122
Fax Number	:	973-633-9922

Provider Business Practice Location Address
First Line	:	1680 STATE ROUTE 23 STE 250
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7520
Country	:	US
Telephone Number	:	973-633-1122
Fax Number	:	973-832-7550

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/10/2020

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