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NPI Code Detail

MEDICARE: MR. SURESH WATTAMWAR R.PH.

MEDICARE: MR. SURESH WATTAMWAR R.PH.
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
1183500000XPharmacist031092NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1031092OTHERNYSTATE PHARM LICENCE

General Provider Information

NPI Number : 1518024066
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SURESH WATTAMWAR R.PH.
Provider Business Mailing Address
First Line : 26 IRVING DR
Second Line :
City : WOODBURY
State : NY
Zip : 11797-1333
Country : US
Telephone Number : 516-367-4317
Fax Number :
Provider Business Practice Location Address
First Line : 312 RALPH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11233-3022
Country : US
Telephone Number : 718-774-6800
Fax Number : 718-774-1776
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 07/08/2007

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