Basic Information
| Provider Information | |||||||||
| NPI: | 1043844905 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SU SALUD MEDICAL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 WILLOW RD | ||||||||
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| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110403326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188443360 | ||||||||
| FaxNumber: | 7185655686 | ||||||||
| Practice Location | |||||||||
| Address1: | 3508 JUNCTION BLVD | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113681743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9177450001 | ||||||||
| FaxNumber: | 6466800078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2020 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | KHANDKER | ||||||||
| AuthorizedOfficialFirstName: | FERDOUS | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 7188443360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.