MEDICARE: DR. SURENDRA SUGRIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	254420	NY

General Provider Information

NPI Number	:	1033341185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURENDRA SUGRIM MD

Provider Business Mailing Address
First Line	:	13106 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-3124
Country	:	US
Telephone Number	:	718-322-5322
Fax Number	:	718-322-5323

Provider Business Practice Location Address
First Line	:	13106 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-3124
Country	:	US
Telephone Number	:	718-322-5322
Fax Number	:	718-322-5323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	05/12/2025

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