Provider Demographics
NPI:1043399769
Name:NGADIMAN, SUTINI (MD)
Entity Type:Individual
Prefix:
First Name:SUTINI
Middle Name:
Last Name:NGADIMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PRESTWICK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950
Mailing Address - Country:US
Mailing Address - Phone:845-483-6447
Mailing Address - Fax:
Practice Address - Street 1:45 READE PLACE
Practice Address - Street 2:VASSAR BROTHERS MEDICAL CENTER
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-483-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA7212207ZP0101X
NY187573207ZP0101X
MN34487207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP4551Medicaid
NYG10180Medicare ID - Type Unspecified