Healthcare Provider Details

I. General information

NPI: 1962557785
Provider Name (Legal Business Name): SURUJPAUL RAGNAUTH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11302 107TH AVE
SOUTH RICHMOND HILL NY
11419-2502
US

IV. Provider business mailing address

11302 107TH AVE
SOUTH RICHMOND HILL NY
11419-2502
US

V. Phone/Fax

Practice location:
  • Phone: 718-323-2435
  • Fax:
Mailing address:
  • Phone: 718-323-2435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberB7182575
License Number StateNY

VIII. Authorized Official

Name: SURUJPAUL RAGNAUTH
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 718-323-2435