Healthcare Provider Details

I. General information

NPI: 1992779284
Provider Name (Legal Business Name): SOOSAIPILLAI GERARD JEYAPALAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 RIDGE RD SUITE 130
WEST SENECA NY
14224-3332
US

IV. Provider business mailing address

1900 RIDE ROAD SUITE 130
WEST SENECA NY
14224
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-0707
  • Fax: 716-961-3706
Mailing address:
  • Phone: 716-675-0707
  • Fax: 716-961-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number128590
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: