Provider Demographics
NPI:1932141017
Name:SURAHIO, MUZAFAR H (MD)
Entity Type:Individual
Prefix:
First Name:MUZAFAR
Middle Name:H
Last Name:SURAHIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 SCHENECTADY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1821
Mailing Address - Country:US
Mailing Address - Phone:347-522-3513
Mailing Address - Fax:347-522-3513
Practice Address - Street 1:15 RUMPLERT CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1903
Practice Address - Country:US
Practice Address - Phone:347-522-3513
Practice Address - Fax:347-522-3513
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2045331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
861391Medicare ID - Type Unspecified
F46076Medicare UPIN