Provider Demographics
NPI:1790826949
Name:SURANENI, A KUMAR (BS)
Entity Type:Individual
Prefix:MR
First Name:A KUMAR
Middle Name:
Last Name:SURANENI
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3705
Mailing Address - Country:US
Mailing Address - Phone:212-568-1300
Mailing Address - Fax:212-927-3960
Practice Address - Street 1:605 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3705
Practice Address - Country:US
Practice Address - Phone:212-568-1300
Practice Address - Fax:212-927-3960
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist