Healthcare Provider Details

I. General information

NPI: 1104838366
Provider Name (Legal Business Name): FOUAD SURUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 E 67TH ST 2C
NEW YORK NY
10021-5914
US

IV. Provider business mailing address

167 E 67TH ST 2C
NEW YORK NY
10021-5914
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-1239
  • Fax: 212-746-6933
Mailing address:
  • Phone: 212-734-1239
  • Fax: 212-746-6933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number105672
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: