Provider Demographics
NPI:1992779284
Name:JEYAPALAN, SOOSAIPILLAI GERARD (MD)
Entity type:Individual
Prefix:
First Name:SOOSAIPILLAI
Middle Name:GERARD
Last Name:JEYAPALAN
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 1:1900 RIDE ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-675-0707
Mailing Address - Fax:716-961-3706
Practice Address - Street 1:1900 RIDGE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3332
Practice Address - Country:US
Practice Address - Phone:716-675-0707
Practice Address - Fax:716-961-3706
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128590207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B36135Medicare UPIN
NYSJ081801Medicare ID - Type Unspecified