Provider Demographics
NPI:1982629184
Name:SHARMA, SURENDRA M (MD)
Entity Type:Individual
Prefix:
First Name:SURENDRA
Middle Name:M
Last Name:SHARMA
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 1:151 48TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-6427
Mailing Address - Country:US
Mailing Address - Phone:845-863-6800
Mailing Address - Fax:201-223-2293
Practice Address - Street 1:151 48TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6427
Practice Address - Country:US
Practice Address - Phone:845-863-6800
Practice Address - Fax:201-223-2293
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03585900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ678742Medicare PIN
NJA62483Medicare UPIN