Provider Demographics
NPI:1427182518
Name:PATTI, SURINDER SINGH (MD)
Entity Type:Individual
Prefix:MR
First Name:SURINDER
Middle Name:SINGH
Last Name:PATTI
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 1:1 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0052
Mailing Address - Country:US
Mailing Address - Phone:212-318-4242
Mailing Address - Fax:212-848-6384
Practice Address - Street 1:213-02 HILLSIDE AV
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11427
Practice Address - Country:US
Practice Address - Phone:718-465-7746
Practice Address - Fax:718-465-1199
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14904001207R00000X
NY149040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00754958Medicaid
NY00754958Medicaid