Provider Demographics
NPI:1568549137
Name:SURAKANTI, SUJANI GANGA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJANI
Middle Name:GANGA
Last Name:SURAKANTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUJANI
Other - Middle Name:
Other - Last Name:GANGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:195 LITTLE ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1914
Mailing Address - Country:US
Mailing Address - Phone:732-235-2465
Mailing Address - Fax:732-235-7355
Practice Address - Street 1:195 LITTLE ALBANY ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1914
Practice Address - Country:US
Practice Address - Phone:732-235-2465
Practice Address - Fax:732-235-7355
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112839207R00000X
NY60-246922207R00000X, 207RH0003X
NJ25MA08677300207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0299537Medicaid
NJ244250AHEMedicare PIN