Provider Demographics
NPI:1134159742
Name:SUTHERLAND, JOHN R J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R J
Last Name:SUTHERLAND
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 1:222 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3348
Mailing Address - Country:US
Mailing Address - Phone:732-914-1919
Mailing Address - Fax:732-914-0210
Practice Address - Street 1:222 OAK AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3348
Practice Address - Country:US
Practice Address - Phone:732-914-1919
Practice Address - Fax:732-914-0210
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04504600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJVP017OtherOXFORD
NJ0264429000OtherAMERIHEALTH NJ PA DEL
NJ7273693OtherCIGNA COMED
NJ1330004Medicaid
NJ7273693OtherCIGNA PPO
NJF02901OtherHEALTH NET PHS
NJ502873OtherAMERIHEALTH ADMIN
NJ010045046NJ01OtherST BARNABAS HEALTHCARE SY
NJ7273693003OtherCIGNA HMO
NJ7273693OtherCIGNA PPO
NJ502873B80Medicare ID - Type Unspecified