Provider Demographics
NPI:1093046807
Name:SURESHBABU KURRA MD LLC
Entity Type:Organization
Organization Name:SURESHBABU KURRA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESHBABU
Authorized Official - Middle Name:
Authorized Official - Last Name:KURRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-213-4021
Mailing Address - Street 1:132 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-2116
Mailing Address - Country:US
Mailing Address - Phone:201-213-4021
Mailing Address - Fax:
Practice Address - Street 1:7 HYDE PARK PL
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1152
Practice Address - Country:US
Practice Address - Phone:201-213-4021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40442261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)