Provider Demographics
NPI:1982870580
Name:SURATWALA, HIREN JUGMOHAN
Entity Type:Individual
Prefix:
First Name:HIREN
Middle Name:JUGMOHAN
Last Name:SURATWALA
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 1:13906 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2926
Mailing Address - Country:US
Mailing Address - Phone:917-414-7706
Mailing Address - Fax:
Practice Address - Street 1:13906 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-2926
Practice Address - Country:US
Practice Address - Phone:917-414-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program