Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | MA35415 | NJ |
NPI | 1093795015 |
---|---|
Provider Name | Dr. John M. Sundheim |
First Address | Toms River, NJ 08753-2200 |
Second Address | Toms River, NJ 08753-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 01/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2954206 | (05) | NJ |
C53691 | (02) | NJ |