Provider Demographics
NPI:1477353852
Name:SUNDERRAM, SANJIV
Entity type:Individual
Prefix:
First Name:SANJIV
Middle Name:
Last Name:SUNDERRAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E 30TH ST APT 7G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8287
Mailing Address - Country:US
Mailing Address - Phone:609-439-7724
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-0058
Practice Address - Country:US
Practice Address - Phone:646-397-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health