Provider Demographics
NPI:1114971397
Name:IRAKAM, SURYA P (MD)
Entity Type:Individual
Prefix:
First Name:SURYA
Middle Name:P
Last Name:IRAKAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3043
Mailing Address - Country:US
Mailing Address - Phone:908-231-1999
Mailing Address - Fax:908-231-1612
Practice Address - Street 1:25 MONROE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3043
Practice Address - Country:US
Practice Address - Phone:908-231-1999
Practice Address - Fax:908-231-1612
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06747400207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9101608Medicaid
NJ9101608Medicaid