Provider Demographics
NPI:1134319635
Name:HERTZEL K SURE MD LLC
Entity Type:Organization
Organization Name:HERTZEL K SURE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERTZEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-760-0797
Mailing Address - Street 1:9425 60TH AVE
Mailing Address - Street 2:UNIT B4
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5069
Mailing Address - Country:US
Mailing Address - Phone:718-760-0797
Mailing Address - Fax:718-760-5552
Practice Address - Street 1:9425 60TH AVE
Practice Address - Street 2:UNIT B4
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5069
Practice Address - Country:US
Practice Address - Phone:718-760-0797
Practice Address - Fax:718-760-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty