Provider Demographics
NPI:1154362739
Name:SANDHU, SURINDER S (MD)
Entity type:Individual
Prefix:
First Name:SURINDER
Middle Name:S
Last Name:SANDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2311
Mailing Address - Country:US
Mailing Address - Phone:516-224-4156
Mailing Address - Fax:516-224-4156
Practice Address - Street 1:585 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2311
Practice Address - Country:US
Practice Address - Phone:516-224-4156
Practice Address - Fax:516-224-4156
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205145207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01854457Medicaid
G87269Medicare UPIN
05B421Medicare ID - Type Unspecified