Provider Demographics
NPI:1114034048
Name:KOSHY, SURESH OOMMEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:OOMMEN
Last Name:KOSHY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 N BROADWAY STE 7
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1303
Mailing Address - Country:US
Mailing Address - Phone:914-969-0168
Mailing Address - Fax:914-969-6237
Practice Address - Street 1:1034 N BROADWAY STE 7
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1303
Practice Address - Country:US
Practice Address - Phone:914-969-0168
Practice Address - Fax:914-969-6237
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0498531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice