Provider Demographics
NPI:1083617112
Name:PALAT, SUJATHA KONNANATH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJATHA
Middle Name:KONNANATH
Last Name:PALAT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:136 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2114
Mailing Address - Country:US
Mailing Address - Phone:631-724-3155
Mailing Address - Fax:
Practice Address - Street 1:1STADIUM RD,STUDENT HEALTH SERVICE, STONYBROOK UNIV
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3191
Practice Address - Country:US
Practice Address - Phone:631-632-6740
Practice Address - Fax:631-632-6936
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY227146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH33649Medicare UPIN