Provider Demographics
NPI:1477830255
Name:REMERSU, BABA SUSHANT (MD)
Entity Type:Individual
Prefix:
First Name:BABA SUSHANT
Middle Name:
Last Name:REMERSU
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 1:1650 SELWYN AVE APT 14F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7666
Mailing Address - Country:US
Mailing Address - Phone:646-724-1634
Mailing Address - Fax:718-960-1370
Practice Address - Street 1:1650 SELWYN AVE APT 14F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7666
Practice Address - Country:US
Practice Address - Phone:646-724-1634
Practice Address - Fax:718-960-1370
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program