Provider Demographics
NPI:1255693628
Name:GHOSH, SUMAN
Entity type:Individual
Prefix:MR
First Name:SUMAN
Middle Name:
Last Name:GHOSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-15, 43RD AV
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE,QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11104
Mailing Address - Country:US
Mailing Address - Phone:718-433-4735
Mailing Address - Fax:
Practice Address - Street 1:47-15, 43RD AV
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE,QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11104
Practice Address - Country:US
Practice Address - Phone:718-433-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist