Provider Demographics
NPI:1205806924
Name:KANUMURY, SUNITA (MD)
Entity type:Individual
Prefix:DR
First Name:SUNITA
Middle Name:
Last Name:KANUMURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 E MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2554
Mailing Address - Country:US
Mailing Address - Phone:973-627-1000
Mailing Address - Fax:973-627-0443
Practice Address - Street 1:496 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2554
Practice Address - Country:US
Practice Address - Phone:973-627-1000
Practice Address - Fax:973-627-0443
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA056665174400000X
NJ25MA056665207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6325408Medicaid
NJ853226UDSMedicare ID - Type UnspecifiedRENDERING PHYSICIAN I.D.
NJ6325408Medicaid
G25591Medicare UPIN