Provider Demographics
NPI:1598982209
Name:CHANDRASEKARAN, SUNDARARAJA (MD)
Entity Type:Individual
Prefix:
First Name:SUNDARARAJA
Middle Name:
Last Name:CHANDRASEKARAN
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 1:148 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3015
Mailing Address - Country:US
Mailing Address - Phone:516-484-3391
Mailing Address - Fax:516-484-0634
Practice Address - Street 1:148 DOGWOOD RD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3015
Practice Address - Country:US
Practice Address - Phone:516-484-3391
Practice Address - Fax:516-484-0634
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine