Provider Demographics
NPI:1245313931
Name:GIRI, SURESH CHANDER (MD)
Entity type:Individual
Prefix:
First Name:SURESH
Middle Name:CHANDER
Last Name:GIRI
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 1:101 PROSPECT STREET
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-864-7776
Mailing Address - Fax:732-905-9407
Practice Address - Street 1:101 PROSPECT STREET
Practice Address - Street 2:SUITE 211
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-864-7776
Practice Address - Fax:732-905-9407
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04234900207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA04234900OtherNJ LICS
NJ3376001Medicaid
NJ3376001Medicaid
AG2160187OtherDEA