Provider Demographics
NPI:1366408056
Name:SUTARIA, HASMUKH (MD)
Entity type:Individual
Prefix:MR
First Name:HASMUKH
Middle Name:
Last Name:SUTARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HASMUKH
Other - Middle Name:
Other - Last Name:SUTARIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:40, UNION AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111
Mailing Address - Country:US
Mailing Address - Phone:973-373-1196
Mailing Address - Fax:973-373-1197
Practice Address - Street 1:40, UNION AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-373-1196
Practice Address - Fax:973-373-1197
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ476262084N0400X
NJMA0476262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5467004Medicaid
NJ425644Medicare PIN
NJ5467004Medicaid