Provider Demographics
NPI:1205821485
Name:PARIKH, SURYAKANT B (MD)
Entity Type:Individual
Prefix:MR
First Name:SURYAKANT
Middle Name:B
Last Name:PARIKH
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 1:111 CARLETON AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2236
Mailing Address - Country:US
Mailing Address - Phone:631-581-0300
Mailing Address - Fax:631-581-2619
Practice Address - Street 1:111 CARLETON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2236
Practice Address - Country:US
Practice Address - Phone:631-581-0300
Practice Address - Fax:631-581-2619
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00212395Medicaid
641841Medicare ID - Type Unspecified
B78551Medicare UPIN