Provider Demographics
NPI:1134170731
Name:SUKHRAJ, GOPAL (PA)
Entity type:Individual
Prefix:
First Name:GOPAL
Middle Name:
Last Name:SUKHRAJ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MARCUS DRIVE
Mailing Address - Street 2:JAMAICA HOSPITAL EMERGENCY DEPT
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:631-391-7700
Mailing Address - Fax:631-454-4161
Practice Address - Street 1:8900 VAN WYCK EXPY
Practice Address - Street 2:JAMAICA HOSPITAL EMERGENCY DEPT
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2897
Practice Address - Country:US
Practice Address - Phone:718-206-8918
Practice Address - Fax:631-454-4161
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02769588Medicaid
NYQ41610Medicare UPIN
NY02769588Medicaid