Provider Demographics
NPI:1457392979
Name:SURACI, PATRICK J (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:SURACI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8 GRAMERCY PARK S
Mailing Address - Street 2:APT 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1718
Mailing Address - Country:US
Mailing Address - Phone:212-473-5966
Mailing Address - Fax:212-614-9143
Practice Address - Street 1:8 GRAMERCY PARK S
Practice Address - Street 2:APT 4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1718
Practice Address - Country:US
Practice Address - Phone:212-473-5966
Practice Address - Fax:212-614-9143
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY007133-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPS0V514810OtherEMPIRE BC/BS
0088924OtherGHI
P576077OtherOXFORD HEALTH PLANS
NYPS0V514810Medicare ID - Type Unspecified