Provider Demographics
NPI:1346556792
Name:MAMATHA SUNDARESH MD
Entity Type:Organization
Organization Name:MAMATHA SUNDARESH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAMATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDARESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-353-8348
Mailing Address - Street 1:149-45 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-353-8348
Mailing Address - Fax:
Practice Address - Street 1:149-45 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-353-8348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty