Basic Information
| Provider Information | |||||||||
| NPI: | 1679210751 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SURESHBABU | ||||||||
| FirstName: | SUDIPTA | ||||||||
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| Credential: | DO, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 TERRACE BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110404340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167323829 | ||||||||
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| Practice Location | |||||||||
| Address1: | NYU LANGONE HOSPITAL- LONG ISLAND | ||||||||
| Address2: | 222 STATION PLAZA, SUITE 509 | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166632381 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2022 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.