Provider Demographics
NPI:1366851156
Name:VISWANATHAN, SUNDAR (PT)
Entity Type:Individual
Prefix:MR
First Name:SUNDAR
Middle Name:
Last Name:VISWANATHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 PLAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5719
Mailing Address - Country:US
Mailing Address - Phone:631-220-4234
Mailing Address - Fax:866-246-2954
Practice Address - Street 1:694 FORT SALONGA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3147
Practice Address - Country:US
Practice Address - Phone:631-623-6371
Practice Address - Fax:866-246-2954
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist