Provider Demographics
NPI:1194062620
Name:SURACE, JOSEPH J III (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:SURACE
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 105TH ST
Mailing Address - Street 2:APT. 7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4739
Mailing Address - Country:US
Mailing Address - Phone:516-313-6561
Mailing Address - Fax:
Practice Address - Street 1:235 E 105TH ST
Practice Address - Street 2:APT. 7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4739
Practice Address - Country:US
Practice Address - Phone:516-313-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270547-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology