Provider Demographics
NPI:1982980348
Name:SURINDER S. BATH, M.D.P.C.
Entity Type:Organization
Organization Name:SURINDER S. BATH, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-798-2699
Mailing Address - Street 1:911 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1039
Mailing Address - Country:US
Mailing Address - Phone:585-798-2699
Mailing Address - Fax:585-798-3196
Practice Address - Street 1:911 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1039
Practice Address - Country:US
Practice Address - Phone:585-798-2699
Practice Address - Fax:585-798-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00453750Medicaid
NY00453750Medicaid