Provider Demographics
NPI:1922177302
Name:SUTIN, DAVID GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GREGORY
Last Name:SUTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 SINGLEY CT
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1609
Mailing Address - Country:US
Mailing Address - Phone:516-498-2055
Mailing Address - Fax:
Practice Address - Street 1:FIRST AVENUE AND 27TH STREET
Practice Address - Street 2:BELLEVUE GERIATRIC CLINIC
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-562-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183032207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF19326Medicare UPIN