Provider Demographics
NPI:1124310404
Name:SUNDARAM, ASHANY (MD)
Entity type:Individual
Prefix:DR
First Name:ASHANY
Middle Name:
Last Name:SUNDARAM
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:PO BOX 419430
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9430
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:201-483-2242
Practice Address - Street 1:1129 BLOOMFIELD AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7123
Practice Address - Country:US
Practice Address - Phone:973-429-6864
Practice Address - Fax:973-521-7888
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10037100207Q00000X
NC2014-01851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine