Provider Demographics
NPI:1639676216
Name:SUDHIR DIWAN MD, LLC
Entity Type:Organization
Organization Name:SUDHIR DIWAN MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DIWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-535-3505
Mailing Address - Street 1:115 E 57TH ST STE 610
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2129
Mailing Address - Country:US
Mailing Address - Phone:212-535-3505
Mailing Address - Fax:212-535-3568
Practice Address - Street 1:115 E 57TH ST STE 610
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2129
Practice Address - Country:US
Practice Address - Phone:212-535-3505
Practice Address - Fax:212-535-3568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209697207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty