Provider Demographics
NPI:1437166956
Name:MODY, SURESH P (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:P
Last Name:MODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:579A CRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5426
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-955-8874
Practice Address - Street 1:483 CRANBURY RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3610
Practice Address - Country:US
Practice Address - Phone:732-390-0030
Practice Address - Fax:732-390-5383
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA056741002085R0202X, 2085R0202X, 2085R0205X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7223307Medicaid
NJ36491OtherAMERIGROUP
NJ8211743OtherGHI
NJ265605OtherAETNA HMO
NJHU0000122OtherAMERICHOICE
NJ0732030000OtherAMERIHEALTH
NJ154366OtherUNITED HEALTHCARE
NJ5H652OtherWELLCHOICE
NJ7223307Medicaid
NJ300107809OtherRAILROAD MEDICARE
NJ5211565OtherAETNA TRADITIONAL PLANS
NJ1107261OtherHORIZON NJ HEALTH
NJP1916600OtherOXFORD
NJ5211565OtherAETNA TRADITIONAL PLANS