Individual provider Active NPI

Catherine Sundholm

  • Physician Assistant
  • Wayne, NJ
National Provider Identifier
1366211724
Registry record updated Apr 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00809900 Issued in NJ
Practice address
201 Berdan Ave
Wayne, NJ 07470-3236
Phone
(201) 612-9988
Fax
(201) 445-9050
NPI assigned
Dec 27, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00809900 NJ Primary

Addresses

Primary practice location

201 Berdan Ave
Wayne, NJ 07470-3236

Mailing address

PO Box 416457
Boston, MA 02241-6457
Phone (844) 362-1735

Other practice location 1

55 Madison Ave Ste 360
Morristown, NJ 07960-7390
Phone (973) 971-7830

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240208000046 NJ Practitioner - Physician Assistant 4587007406 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00809900NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Practice Associates Medical Group CurrentSince Apr 1, 2026 Accepting new patients
Ahs Hospital Corp PastSince Apr 1, 2026 Accepting new patients

Locations

55 Madison Ave
Ste 360
Morristown, NJ 07960
Phone (973) 971-5996

201 Berdan Ave
Wayne, NJ 07470
Phone (201) 612-9988

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1703635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775001600000",
    "number": "1366211724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416457",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416457",
            "telephone_number": "844-362-1735",
            "fax_number": "973-290-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 BERDAN AVE",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074703236",
            "telephone_number": "201-612-9988",
            "fax_number": "201-445-9050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Madison Ave Ste 360",
            "address_purpose": "LOCATION",
            "city": "Morristown",
            "state": "NJ",
            "postal_code": "079607390",
            "country_code": "US",
            "telephone_number": "973-971-7830",
            "fax_number": "973-267-5060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUNDHOLM",
        "first_name": "CATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-27",
        "last_updated": "2026-04-01",
        "certification_date": "2026-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00809900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

Verify at the official NPI Registry.