Provider Demographics
NPI:1053335976
Name:SUN, XINLAI (MD)
Entity type:Individual
Prefix:
First Name:XINLAI
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEWARK BETH ISRAEL MEDICAL CENTER
Mailing Address - Street 2:201 LYONS AVENUE E/L-4
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112
Mailing Address - Country:US
Mailing Address - Phone:973-926-7580
Mailing Address - Fax:973-705-8301
Practice Address - Street 1:201 LYONS AVE # L-4
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7580
Practice Address - Fax:973-705-8301
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07937400207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00262580OtherOXFORD
NJ0091278Medicaid
NJI34692Medicare UPIN
NJ092694CQQMedicare ID - Type Unspecified