Provider Demographics
NPI:1558636845
Name:SURINDER S MALHOTRA PC
Entity Type:Organization
Organization Name:SURINDER S MALHOTRA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:TATIANA CALVACHE
Authorized Official - Phone:718-830-9000
Mailing Address - Street 1:92-29 QUEENSBLVD
Mailing Address - Street 2:1H
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-830-9000
Mailing Address - Fax:718-897-0443
Practice Address - Street 1:92-29 QUEENSBLVD
Practice Address - Street 2:1H
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-830-9000
Practice Address - Fax:718-897-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY246075Medicaid
NY00697163Medicaid
NY00370374Medicaid