Active NPI
Palanisamy S Sundaram I, M.D
- Pediatrics Physician
- Irvington, NJ
National Provider Identifier
1114010477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA02857500
- Practice address
- 860 Grove St
Irvington, NJ 07111-3601 - Phone
- (973) 399-8650
- Fax
- (973) 533-4470
- NPI assigned
- Oct 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MA02857500 | NJ | Primary |
Addresses
Primary practice location
860 Grove St
Irvington, NJ 07111-3601
Mailing address
860 Grove St
Irvington, NJ 07111-3601
Phone (973) 399-8650
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA02857500 | NJ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251417600000",
"number": "1114010477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "860 GROVE ST",
"city": "IRVINGTON",
"state": "NJ",
"postal_code": "071113601",
"telephone_number": "973-399-8650",
"fax_number": "973-533-4470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "860 GROVE ST",
"city": "IRVINGTON",
"state": "NJ",
"postal_code": "071113601",
"telephone_number": "973-399-8650",
"fax_number": "973-533-4470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUNDARAM",
"first_name": "PALANISAMY",
"middle_name": "S",
"name_prefix": "Dr.",
"name_suffix": "I",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-01",
"last_updated": "2009-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA02857500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvington, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.