Provider Demographics
NPI:1467624114
Name:SOOSAIPILLAI G JEYAPALAN MD KPC
Entity Type:Organization
Organization Name:SOOSAIPILLAI G JEYAPALAN MD KPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SOOSAIPILLAI
Authorized Official - Middle Name:G
Authorized Official - Last Name:JEYAPALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-823-3448
Mailing Address - Street 1:550 N LEGION DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-2452
Mailing Address - Country:US
Mailing Address - Phone:716-823-3448
Mailing Address - Fax:716-826-0800
Practice Address - Street 1:550 N LEGION DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2452
Practice Address - Country:US
Practice Address - Phone:716-823-3448
Practice Address - Fax:716-826-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128590261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care