Provider Demographics
NPI:1184791667
Name:SURESH RAYANCHA MD PC
Entity type:Organization
Organization Name:SURESH RAYANCHA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYANCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-732-8880
Mailing Address - Street 1:1 OXFORD XING
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3200
Mailing Address - Country:US
Mailing Address - Phone:315-732-8880
Mailing Address - Fax:315-732-2705
Practice Address - Street 1:1 OXFORD XING
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-3200
Practice Address - Country:US
Practice Address - Phone:315-732-8880
Practice Address - Fax:315-732-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1561Medicare PIN