Provider Demographics
NPI:1225903214
Name:TAILOR, SUSMEET SUNIL
Entity type:Individual
Prefix:
First Name:SUSMEET
Middle Name:SUNIL
Last Name:TAILOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3438 BELL BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1739
Mailing Address - Country:US
Mailing Address - Phone:718-510-2453
Mailing Address - Fax:
Practice Address - Street 1:70 FATHER CAPODANNO BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4803
Practice Address - Country:US
Practice Address - Phone:718-273-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP138915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine