1104260603 NPI number — DR. VIKRAM KRISHNA SUNDARAM MD

Table of content: DR. VIKRAM KRISHNA SUNDARAM MD (NPI 1104260603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104260603 NPI number — DR. VIKRAM KRISHNA SUNDARAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUNDARAM
Provider First Name:
VIKRAM
Provider Middle Name:
KRISHNA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104260603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1755 YORK AVE APT 7F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10128-6866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-369-8978
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE GUSTAVE L. LEVY PLACE
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-241-7416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 294418 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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