Provider Demographics
NPI:1578305769
Name:SURAJ, FNU (MD)
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:SURAJ
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:SUNY DOWNSTATE HEALTH SCIENCES UNIVERSITY
Mailing Address - Street 2:450 CLARKSON AVE, BOX 52, BROOKLN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-270-2848
Mailing Address - Fax:
Practice Address - Street 1:SUNY DOWNSTATE HEALTH SCIENCES UNIVERSITY
Practice Address - Street 2:450 CLARKSON AVE, BOX 52, BROOKLN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-270-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program