Provider Demographics
NPI:1629397526
Name:SAHA, SURAJIT (MD)
Entity Type:Individual
Prefix:
First Name:SURAJIT
Middle Name:
Last Name:SAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E GATE BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2136
Mailing Address - Country:US
Mailing Address - Phone:516-804-5200
Mailing Address - Fax:516-804-5200
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-766-2519
Practice Address - Fax:516-766-3714
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282736207W00000X
VA0101258938207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04375320Medicaid
NY04375320Medicaid
VAVVI944AMedicare PIN
VA1629397526OtherHUMANA
VA1629397526OtherTRICARE/TRICARE FOR LIFE
VA10154672OtherOPTIMA
VA1629397526OtherVA PREMIER
VAP01548693OtherRR MEDICARE
VA1629397526OtherVHN