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General NPI Number Information
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NPI Number | 1720129737
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Entity Type | Organization
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Legal Business Name | SUJATHA MEDICAL PC
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Dates
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Enumeration Date | 02/11/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 21414 HILLSIDE AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1808
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Country | US
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Telephone | 718-264-2700
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Fax | 718-264-2702
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Provider Business Mailing Address
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Address Line | 6636 YELLOWSTONE BLVD APT. 18F
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City | FOREST HILLS
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State | NY
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Zip | 11375-2510
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Country | US
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Telephone | 718-264-2700
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | SUJATHA RAJAN
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Credential | M.D
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Telephone | 718-264-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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