Provider Demographics
NPI:1083727762
Name:SURE, HERTZEL K (MD)
Entity Type:Individual
Prefix:
First Name:HERTZEL
Middle Name:K
Last Name:SURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
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 1:94-25 60TH AVENUE
Practice Address - Street 2:SUITE B4
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-760-0797
Practice Address - Fax:718-760-5552
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY224296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55850Medicare UPIN
NY05887GMedicare ID - Type Unspecified