Provider Demographics
NPI:1629022140
Name:JOHRI, SURENDRA K (MD)
Entity Type:Individual
Prefix:
First Name:SURENDRA
Middle Name:K
Last Name:JOHRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:175 W MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1300
Mailing Address - Country:US
Mailing Address - Phone:315-508-5083
Mailing Address - Fax:315-823-1889
Practice Address - Street 1:1427 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4343
Practice Address - Country:US
Practice Address - Phone:315-738-1428
Practice Address - Fax:315-738-1461
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY238870-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474180Medicaid
NY01039156Medicaid
NYRB0539Medicare PIN
NYI53866IMedicare UPIN