Sundaresh, Mamatha

Sundaresh, Mamatha is an sole proprietor health care provider with primary practice located at 4802 10Th Ave , Brooklyn NY 11219-2844. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Sundaresh, Mamatha can be contacted via phone (718) 283-7500.

Contact Information

Primary practice address
4802 10Th Ave Brooklyn NY 11219-2844
Phone: (718) 283-7500
Fax: (718) 635-7235
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 190550 New York

Profile Details

NPI number 1629063318
LBN Legal business name Sundaresh, Mamatha
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 19th, 2005
Last updated Feb 5th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629063318 NPPES
New York MEDICAID 01480813
New York Other 11-3563769
New York Other 4604933
New York Other P2163738
New York Other 190550-F15
New York Other 2698609
New York Other 2563948
New York Other 300950401
New York Other BK00828-03

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