Healthcare Provider Details

I. General information

NPI: 1497981765
Provider Name (Legal Business Name): SUMAN GHOSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

5402 FORT HAMILTON PKWY 6TH FLOOR
BROOKLYN NY
11219
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-7500
  • Fax: 718-635-7366
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number316015
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number316015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: