Provider Demographics
NPI:1124464532
Name:SUNRISE MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:SUNRISE MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEERAMACHANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-891-8500
Mailing Address - Street 1:219 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3913
Mailing Address - Country:US
Mailing Address - Phone:917-891-8500
Mailing Address - Fax:917-891-8501
Practice Address - Street 1:543 E 137TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4225
Practice Address - Country:US
Practice Address - Phone:917-891-8500
Practice Address - Fax:917-891-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243118-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY243118-1OtherNEW YORK STATE LICENSE