1972977205 NPI number — STEVEN SUNDERRAJ PT PC

Table of content: (NPI 1972977205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972977205 NPI number — STEVEN SUNDERRAJ PT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN SUNDERRAJ PT PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1972977205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 SEVEN OAKS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANUET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10954-3523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-405-1431
Provider Business Mailing Address Fax Number:
212-223-0198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 SEVEN OAKS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANUET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10954-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-405-1431
Provider Business Practice Location Address Fax Number:
212-223-0198
Provider Enumeration Date:
11/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MARCUS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
212-421-1969

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  034635 , 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)

  • Identifier: A400067797 . This is a "MEDICARE PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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