Provider Demographics
NPI:1447211024
Name:SOUED, GEORGE J (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:SOUED
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 1:364 97TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7850
Mailing Address - Country:US
Mailing Address - Phone:718-748-8787
Mailing Address - Fax:718-745-1617
Practice Address - Street 1:364 97TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7850
Practice Address - Country:US
Practice Address - Phone:718-748-8787
Practice Address - Fax:718-745-1617
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY84F531Medicare PIN
NYF25376Medicare UPIN