Healthcare Provider Details

I. General information

NPI: 1548553951
Provider Name (Legal Business Name): SURYA GUHA MBBS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 TEANECK RD
TEANECK NJ
07666-4245
US

IV. Provider business mailing address

PO BOX 911
RAMSEY NJ
07446-0911
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-3000
  • Fax:
Mailing address:
  • Phone: 201-661-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number25MA09825900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA09825900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: