Provider Demographics
NPI:1962557785
Name:SURUJPAUL RAGNAUTH MD PC
Entity type:Organization
Organization Name:SURUJPAUL RAGNAUTH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SURUJPAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGNAUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-323-2435
Mailing Address - Street 1:11302 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2502
Mailing Address - Country:US
Mailing Address - Phone:718-323-2435
Mailing Address - Fax:
Practice Address - Street 1:11302 107TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2502
Practice Address - Country:US
Practice Address - Phone:718-323-2435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB7182575173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01562110Medicaid
NY01562110Medicaid
NYF52021Medicare UPIN
NY96F581Medicare ID - Type Unspecified