Provider Demographics
NPI:1700868544
Name:SOOD, HARISH C (MD)
Entity Type:Individual
Prefix:
First Name:HARISH
Middle Name:C
Last Name:SOOD
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 1:267 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3625
Mailing Address - Country:US
Mailing Address - Phone:516-889-7010
Mailing Address - Fax:516-889-4229
Practice Address - Street 1:267 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3625
Practice Address - Country:US
Practice Address - Phone:516-889-7010
Practice Address - Fax:516-889-4229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00387191Medicaid
NY00387191Medicaid
B16559Medicare UPIN