1780644070 NPI number — JASVANT S SURANI MD

Table of content: JASVANT S SURANI MD (NPI 1780644070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780644070 NPI number — JASVANT S SURANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SURANI
Provider First Name:
JASVANT
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780644070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 37TH PL
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32960-6501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-569-3212
Provider Business Mailing Address Fax Number:
772-569-1435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 37TH PL
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-569-3212
Provider Business Practice Location Address Fax Number:
772-569-1435
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  1383591 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME103068 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000401250001 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76E60 . This is a "EMPIRE BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00561486 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040426006769 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26112 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10002697 . This is a "CPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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