Provider Demographics
NPI:1396221750
Name:PURKAYASTHA, SUMEDHA (MD)
Entity type:Individual
Prefix:DR
First Name:SUMEDHA
Middle Name:
Last Name:PURKAYASTHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W 57TH ST STE 507
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2826
Mailing Address - Country:US
Mailing Address - Phone:212-337-0600
Mailing Address - Fax:
Practice Address - Street 1:1111 HAZEN ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1377
Practice Address - Country:US
Practice Address - Phone:917-891-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10129542084P0800X
NY3279312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid