NPIMap

Organization Active NPI

Sushil K Mehandru MD PA

  • Preferred Provider Organization
  • Wall Township, NJ
National Provider Identifier
1316132467
Registry record updated Sep 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
MA034596 Issued in NJ
Legal business name
SUSHIL K MEHANDRU MD PA
Practice address
1925 Hwy 35
Wall Township, NJ 07719-3512
Phone
(732) 974-0100
Fax
(732) 974-0137
NPI assigned
Sep 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sushil K Mehandru, MDNPI 1366453409
Title
MD Pressident
Phone
(732) 974-0100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X MA034596 NJ Primary

Addresses

Primary practice location

1925 Hwy 35
Wall Township, NJ 07719-3512

Mailing address

1925 Hwy 35
Wall Township, NJ 07719-3512
Phone (732) 974-0100

Other identifiers 1

IdentifierTypeStateIssuer
2634201MedicaidNJ

Other names 1

  • skmehandrumdpa Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110707000077 NJ Part B Supplier - Clinic/Group Practice 0446438881 Receives reassigned benefits from 1 practitioner
Practice locations: Neptune, NJ

National Provider Directory

National Provider Directory

Locations

2102 State Route 33
Neptune City, NJ 07753
Phone (732) 776-5138

1925 State Route 35
Wall Township, NJ 07719
Phone (732) 974-0100

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222041600000",
    "number": "1316132467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 HWY 35",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077193512",
            "telephone_number": "732-974-0100",
            "fax_number": "732-974-0137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 HWY 35",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077193512",
            "telephone_number": "732-974-0100",
            "fax_number": "732-974-0137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSHIL K MEHANDRU MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2008-09-22",
        "status": "A",
        "authorized_official_last_name": "MEHANDRU",
        "authorized_official_first_name": "SUSHIL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MD PRESSIDENT",
        "authorized_official_telephone_number": "732-974-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NJ",
            "license": "MA034596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2634201",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "skmehandrumdpa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wall Township, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.