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General NPI Number Information
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NPI Number | 1629069901
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Entity Type | Organization
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Legal Business Name | S MADHUSOODANAN MD PC
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | ST JOHNS EPISCOPAL HOSPITAL 327 BEACH CHANNEL DRIVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-1511
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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 | 249 BROADWAY
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City | LAWRENCE
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State | NY
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Zip | 11559-1511
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Country | US
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Telephone | 516-371-1804
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Fax | 516-371-1804
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Authorized Official
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Title or Position | PRESIDENT S. MADHUSOODANAN MD PC
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Name | SUBRAMONIAM MADHUSOODANAN
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Credential | MD
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Telephone | 516-371-1804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 138957
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License Number State | NY
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