Provider Demographics
NPI:1538233242
Name:BELANI, SURESH G (MD)
Entity type:Individual
Prefix:DR
First Name:SURESH
Middle Name:G
Last Name:BELANI
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:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-0648
Mailing Address - Country:US
Mailing Address - Phone:973-372-0528
Mailing Address - Fax:973-372-0094
Practice Address - Street 1:50 UNION AVE
Practice Address - Street 2:SUITE-301
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3262
Practice Address - Country:US
Practice Address - Phone:973-372-0528
Practice Address - Fax:973-372-0094
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04637100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ450945Medicare ID - Type Unspecified
NJD06506Medicare UPIN