Provider Demographics
NPI:1366453409
Name:MEHANDRU, SUSHIL K (MD)
Entity Type:Individual
Prefix:MR
First Name:SUSHIL
Middle Name:K
Last Name:MEHANDRU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 HWY 35
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-974-0100
Mailing Address - Fax:732-974-0137
Practice Address - Street 1:1925 HWY 35 W
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719
Practice Address - Country:US
Practice Address - Phone:732-974-0100
Practice Address - Fax:732-974-0137
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA034596207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2634201Medicaid
C52968Medicare UPIN
NJ2634201Medicaid