Provider Demographics
NPI:1740320845
Name:TANNA, SURESH J (MD)
Entity type:Individual
Prefix:DR
First Name:SURESH
Middle Name:J
Last Name:TANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 OLD NORTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4206
Mailing Address - Country:US
Mailing Address - Phone:631-269-9355
Mailing Address - Fax:631-761-2008
Practice Address - Street 1:PILGRIM PSYCHIATRIC CENTER
Practice Address - Street 2:998 CROOKED HILL RD ,
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-761-3038
Practice Address - Fax:631-761-2008
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1631542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry