Provider Demographics
NPI:1033415294
Name:SURE MEDICAL PC
Entity Type:Organization
Organization Name:SURE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERTZEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-362-8183
Mailing Address - Street 1:9425 60TH AVE STE B-4
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5069
Mailing Address - Country:US
Mailing Address - Phone:718-280-9092
Mailing Address - Fax:914-810-9609
Practice Address - Street 1:9425 60TH AVE
Practice Address - Street 2:SUITE B4
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5069
Practice Address - Country:US
Practice Address - Phone:718-362-8183
Practice Address - Fax:718-362-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55850Medicare UPIN