Basic Information
| Provider Information | |||||||||
| NPI: | 1619298981 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SUSEELAN | ||||||||
| FirstName: | HARY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 ROUTE 55 | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAGRANGEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125405108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454759661 | ||||||||
| FaxNumber: | 8454754993 | ||||||||
| Practice Location | |||||||||
| Address1: | 4068 ALBANY POST RD | ||||||||
| Address2: | |||||||||
| City: | HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125383900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452292123 | ||||||||
| FaxNumber: | 8452296313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2010 | ||||||||
| LastUpdateDate: | 09/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 256391 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 256391 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 256391 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 03766896 | 05 | NY | MEDICAID |