Provider Demographics
NPI:1013614494
Name:S & G MEDICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:S & G MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GORUKANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-331-6064
Mailing Address - Street 1:3350 VICTORY BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6792
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3350 VICTORY BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6792
Practice Address - Country:US
Practice Address - Phone:718-331-6064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty