Provider Demographics
NPI:1851599005
Name:JON R SUNDELL DPM PC
Entity Type:Organization
Organization Name:JON R SUNDELL DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-207-9076
Mailing Address - Street 1:7355 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1426
Mailing Address - Country:US
Mailing Address - Phone:917-207-9076
Mailing Address - Fax:
Practice Address - Street 1:7355 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1426
Practice Address - Country:US
Practice Address - Phone:917-207-9076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005463213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty