Provider Demographics
NPI:1598949000
Name:SUNY DOWNSTATE MEDICAL CENTER
Entity Type:Organization
Organization Name:SUNY DOWNSTATE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW IN CARDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:SUNDER
Authorized Official - Last Name:POLUDASU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-270-1568
Mailing Address - Street 1:1305 GRAVESEND NECK RD
Mailing Address - Street 2:#2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4328
Mailing Address - Country:US
Mailing Address - Phone:646-322-7137
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVE.
Practice Address - Street 2:DEPT. OF MEDICINE, DIV. OF CARDIOLOGY.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-270-1568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital