Basic Information
Provider Information | |||||||||
NPI: | 1487850152 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHERUVU | ||||||||
FirstName: | SUNITA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 416457 | ||||||||
Address2: |   | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 022416457 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9736566280 | ||||||||
FaxNumber: | 9732907495 | ||||||||
Practice Location | |||||||||
Address1: | 100 MADISON AVE | ||||||||
Address2: |   | ||||||||
City: | MORRISTOWN | ||||||||
State: | NJ | ||||||||
PostalCode: | 079606136 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9739715000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/21/2007 | ||||||||
LastUpdateDate: | 06/19/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 249383 | NY | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | MD13301 | RI | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 110087089A | 05 | MA |   | MEDICAID | 11232010 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 001863901 | 01 | RI | RI MEDICARE | OTHER | 11102010 | 01 | RI | BCBSRI | OTHER | 939025129 | 01 | RI | GROUP RI MEDICARE | OTHER | 11112010 | 01 | RI | NHPRI | OTHER | SC82552 | 05 | RI |   | MEDICAID |