Provider Demographics
NPI:1235233362
Name:SUN MEDICAL P.C
Entity Type:Organization
Organization Name:SUN MEDICAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:SUNG WOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-944-3115
Mailing Address - Street 1:339 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-1218
Mailing Address - Country:US
Mailing Address - Phone:201-768-1918
Mailing Address - Fax:
Practice Address - Street 1:2200 FLETCHER AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5005
Practice Address - Country:US
Practice Address - Phone:201-944-3115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07942200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0092312Medicaid
NJ0092312Medicaid
NJ094076VLYMedicare ID - Type Unspecified