Healthcare Provider Details

I. General information

NPI: 1053691808
Provider Name (Legal Business Name): ASIF K SURI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST DEPARTMENT OF RADIOLOGY
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST DEPARTMENT OF RADIOLOGY
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4030
  • Fax:
Mailing address:
  • Phone: 718-920-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number254326
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number254326
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number254326
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: