Provider Demographics
NPI:1922151935
Name:SUNDARAM, KANAGA N (MD)
Entity Type:Individual
Prefix:DR
First Name:KANAGA
Middle Name:N
Last Name:SUNDARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NATARAJAN
Other - Middle Name:
Other - Last Name:KANAGA SUNDARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:29 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2240
Mailing Address - Country:US
Mailing Address - Phone:973-377-4112
Mailing Address - Fax:973-377-2775
Practice Address - Street 1:29 COLUMBIA TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2240
Practice Address - Country:US
Practice Address - Phone:973-377-4112
Practice Address - Fax:973-377-2775
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02811500207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC57203Medicare UPIN