Individual
JAG SUNDERRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 PATERSON ST, SUITE 5200B, NEW BRUNSWICK, NJ 08901-1962
(732) 235-6511
(732) 235-6524
Mailing address
66 W GILBERT ST, 2ND FLOOR, TINTON FALLS, NJ 07701-4947
(732) 212-0051
(732) 212-0713
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
25MA06318500
NJ
207RP1001X
Pulmonary Disease Physician
MA063185
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290012185
R R MCR
NJ
05
—
8025908
—
NJ
Enumeration date
06/20/2006
Last updated
07/23/2021
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