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General NPI Number Information
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NPI Number | 1740320845
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Entity Type | Individual
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Provider Name | SURESH J TANNA M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | PILGRIM PSYCHIATRIC CENTER 998 CROOKED HILL RD ,
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City | BRENTWOOD
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State | NY
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Zip | 11717
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Country | US
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Telephone | 631-761-3038
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Fax | 631-761-2008
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Provider Business Mailing Address
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Address Line | 100 OLD NORTHPORT RD
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City | KINGS PARK
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State | NY
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Zip | 11754-4206
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Country | US
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Telephone | 631-269-9355
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Fax | 631-761-2008
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 163154
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License Number State | NY
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