=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558593525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUMA SUDHEENDRAN KAMATH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2009
-----------------------------------------------------
Last Update Date | 12/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5645 MAIN ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-5045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-7082
-----------------------------------------------------
Fax | 212-305-8995
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 REDFIELD ST
-----------------------------------------------------
City | RYE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10580-3406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-515-2093
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0206X
-----------------------------------------------------
Taxonomy Name | Pediatric Gastroenterology Physician
-----------------------------------------------------
License Number | 253145
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------