Active NPI
Raghunandan Sundaram, M.D
- Pediatrics Physician
- Elizabeth, NJ
National Provider Identifier
1760555007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA07433200
- Practice address
- 817 Rahway Ave
Elizabeth, NJ 07202-2212 - Phone
- (908) 355-7365
- Fax
- (908) 355-2452
- NPI assigned
- Nov 16, 2006
- Last updated
- Jul 8, 2007
- 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 | 25MA07433200 | NJ | Primary |
Addresses
Primary practice location
817 Rahway Ave
Elizabeth, NJ 07202-2212
Mailing address
7 Renee CT
Edison, NJ 08820-3634
Phone (732) 662-1403
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4544682 | Medicaid | MI |
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 |
|---|---|---|---|
| 25MA07433200 | NJ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Newark Beth Israel Medical Center Inc | Past | Accepting new patients | |
| Trinitas Regional Medical Center | Past | Accepting new patients | |
| Union County Pediatrics Group Inc | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/23997/brand/1/csg/1/fhir/r4
- raghunandan.sundaram.1@23997.direct.athenahealth.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Newark Beth Israel Medical Center
- General Acute Care Hospital
- Newark, NJ
- NPI 1215027966
-
- General Acute Care Hospital
- Elizabeth, NJ
- NPI 1770583999
-
- Pediatrics Physician
- Elizabeth, NJ
- NPI 1831379841
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760555007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 RENEE CT",
"city": "EDISON",
"state": "NJ",
"postal_code": "088203634",
"telephone_number": "732-662-1403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "817 RAHWAY AVE",
"city": "ELIZABETH",
"state": "NJ",
"postal_code": "072022212",
"telephone_number": "908-355-7365",
"fax_number": "908-355-2452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUNDARAM",
"first_name": "RAGHUNANDAN",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA07433200",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4544682",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elizabeth, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.