Individual
DR. BALAJI SUTHARSANAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 996-2000
Mailing address
60 VILLAGE RD, KENDALL PARK, NJ 08824-1546
(908) 616-3097
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
25MA10631300
NJ
390200000X
Student in an Organized Health Care Education/Training Program
S94800710005902
NJ
Other
Enumeration date
06/02/2016
Last updated
09/03/2019
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