Provider Demographics
NPI:1164448585
Name:BEKAL, SURESH
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:
Last Name:BEKAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SANITORIUM RD
Mailing Address - Street 2:BUILDING D
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3555
Mailing Address - Country:US
Mailing Address - Phone:845-364-2512
Mailing Address - Fax:845-364-2628
Practice Address - Street 1:50 SANITORIUM RD
Practice Address - Street 2:BUILDING D
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3555
Practice Address - Country:US
Practice Address - Phone:845-364-2512
Practice Address - Fax:845-364-2628
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00130523208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSB0205911Medicaid
NYE28889Medicare UPIN