Provider Demographics
NPI:1700034105
Name:SAHA, SUMAN
Entity Type:Individual
Prefix:MR
First Name:SUMAN
Middle Name:
Last Name:SAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013B PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3989
Mailing Address - Country:US
Mailing Address - Phone:516-279-6991
Mailing Address - Fax:516-279-6993
Practice Address - Street 1:1013B PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3989
Practice Address - Country:US
Practice Address - Phone:516-279-6991
Practice Address - Fax:718-279-6993
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist