Provider Demographics
NPI:1811027220
Name:MOHANDOSS, SUNDARARAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNDARARAJU
Middle Name:
Last Name:MOHANDOSS
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 1:1898 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7202
Mailing Address - Country:US
Mailing Address - Phone:718-863-1083
Mailing Address - Fax:718-892-2033
Practice Address - Street 1:1898 WOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7202
Practice Address - Country:US
Practice Address - Phone:718-863-1083
Practice Address - Fax:718-892-2033
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00238904Medicaid
NYB12988Medicare UPIN
NY322071Medicare PIN