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General NPI Number Information
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NPI Number | 1033139803
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Entity Type | Individual
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Provider Name | SURESH KUMAR NAHATA MD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 327 BEACH 19TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4423
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Country | US
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Telephone | 718-869-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 200 BRIGHTON 15TH ST APT. 3F
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City | BROOKLYN
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State | NY
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Zip | 11235-5842
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Country | US
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Telephone | 917-596-7193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 245485
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License Number State | NY
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