Provider Demographics
NPI:1629034533
Name:MALHOTRA, SURAJ PRAKASH (MD)
Entity Type:Individual
Prefix:DR
First Name:SURAJ
Middle Name:PRAKASH
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 PINE WOODS RD
Mailing Address - Street 2:STE 2
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538
Mailing Address - Country:US
Mailing Address - Phone:845-229-9121
Mailing Address - Fax:845-229-6945
Practice Address - Street 1:7 PINE WOODS RD
Practice Address - Street 2:STE 2
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538
Practice Address - Country:US
Practice Address - Phone:845-229-9121
Practice Address - Fax:845-229-6945
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118216208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00382201Medicaid
C08239Medicare UPIN
NY00382201Medicaid