Healthcare Provider Details

I. General information

NPI: 1144474313
Provider Name (Legal Business Name): SURYA HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 MCBRIDE AVE SUITE D 208
WEST PATERSON NJ
07424-2559
US

IV. Provider business mailing address

1031 MCBRIDE AVE STE D208
WOODLAND PARK NJ
07424-2569
US

V. Phone/Fax

Practice location:
  • Phone: 738-121-0109
  • Fax: 973-200-0120
Mailing address:
  • Phone: 973-812-1010
  • Fax: 973-200-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISHNA V BHASKARABHATLA
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 973-812-1010