Provider Demographics
NPI:1568750263
Name:HASMUKH SUTARIA,M.D. PA
Entity Type:Organization
Organization Name:HASMUKH SUTARIA,M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HASMUKH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-756-2002
Mailing Address - Street 1:40 UNION AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3277
Mailing Address - Country:US
Mailing Address - Phone:973-373-1196
Mailing Address - Fax:973-373-1197
Practice Address - Street 1:40 UNION AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3277
Practice Address - Country:US
Practice Address - Phone:973-373-1196
Practice Address - Fax:973-373-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0476262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5467004Medicaid
NJ425644Medicare PIN
NJC33902Medicare UPIN