Individual
SURESH PANDANTHARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
901 W MAIN ST STE 160, FREEHOLD, NJ 07728-2537
(732) 577-0600
(732) 577-6332
Mailing address
PO BOX 416457, BOSTON, MA 02241-6457
(844) 362-1735
(973) 290-7495
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26NJ00665300
NJ
Other
Enumeration date
09/05/2016
Last updated
11/02/2021
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