Provider Demographics
NPI:1215190756
Name:SUTARIYA, DHARMESHKUMAR VALLABHBHAI (MD)
Entity Type:Individual
Prefix:
First Name:DHARMESHKUMAR
Middle Name:VALLABHBHAI
Last Name:SUTARIYA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3435 70TH ST
Mailing Address - Street 2:QUEENS ARTIFICIAL KIDNEY CENTER
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1055
Mailing Address - Country:US
Mailing Address - Phone:718-651-9700
Mailing Address - Fax:718-533-0264
Practice Address - Street 1:3435 70TH ST
Practice Address - Street 2:QUEENS ARTIFICIAL KIDNEY CENTER
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1055
Practice Address - Country:US
Practice Address - Phone:718-651-9700
Practice Address - Fax:718-533-0264
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2018-12-13
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Provider Licenses
StateLicense IDTaxonomies
NY249408207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03152196Medicaid