Provider Demographics
NPI:1679210751
Name:SURESHBABU, SUDIPTA (DO, MS)
Entity Type:Individual
Prefix:
First Name:SUDIPTA
Middle Name:
Last Name:SURESHBABU
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TERRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4340
Mailing Address - Country:US
Mailing Address - Phone:516-732-3829
Mailing Address - Fax:
Practice Address - Street 1:NYU LANGONE HOSPITAL- LONG ISLAND
Practice Address - Street 2:222 STATION PLAZA, SUITE 509
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-663-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program