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General NPI Number Information
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NPI Number | 1871145417
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Entity Type | Individual
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Provider Name | MADHUVANTHI SURESH PHD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2019
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 530 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6402
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Country | US
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Telephone | 212-263-6159
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Fax | 646-501-9872
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Provider Business Mailing Address
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Address Line | 700 HICKSVILLE RD STE 205
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City | BETHPAGE
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State | NY
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Zip | 11714-3472
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Country | US
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Telephone | 646-501-3229
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Fax | 212-263-4539
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 025745-01
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License Number State | NY
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