Healthcare Provider Details

I. General information

NPI: 1417240268
Provider Name (Legal Business Name): SUPREETI BEHURIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVE STE 200
STATEN ISLAND NY
10305-3400
US

IV. Provider business mailing address

501 SEAVIEW AVE STE 200
STATEN ISLAND NY
10305-3400
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-5800
  • Fax: 718-226-7891
Mailing address:
  • Phone: 718-226-5800
  • Fax: 718-226-7891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number68116-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number68116-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number273407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: