Healthcare Provider Details

I. General information

NPI: 1104088269
Provider Name (Legal Business Name): PAYAL SUD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAYAL SUD

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CHERRY DR E
PLAINVIEW NY
11803
US

IV. Provider business mailing address

47 CHERRY DR E
PLAINVIEW NY
11803-2016
US

V. Phone/Fax

Practice location:
  • Phone: 414-324-6566
  • Fax:
Mailing address:
  • Phone: 516-650-9179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number254251
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number254251
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: