Provider Demographics
NPI:1750556403
Name:S. SWAMY SURASI, MDPC
Entity type:Organization
Organization Name:S. SWAMY SURASI, MDPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIKRISHNA
Authorized Official - Middle Name:SWAMY
Authorized Official - Last Name:SURASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-596-4400
Mailing Address - Street 1:142 JORALEMON ST
Mailing Address - Street 2:STE 9B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4709
Mailing Address - Country:US
Mailing Address - Phone:718-596-4400
Mailing Address - Fax:718-596-3332
Practice Address - Street 1:142 JORALEMON ST STE 9B
Practice Address - Street 2:BROOKLYN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4709
Practice Address - Country:US
Practice Address - Phone:718-596-4400
Practice Address - Fax:718-596-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00700096Medicaid
NY33A221OtherP10
NYD33360Medicare UPIN