Provider Demographics
NPI:1902967706
Name:DHAMI, SURJIT K (MD)
Entity Type:Individual
Prefix:MRS
First Name:SURJIT
Middle Name:K
Last Name:DHAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SURJIT
Other - Middle Name:K
Other - Last Name:KHAHRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:27 RESERVOIR DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6846
Mailing Address - Country:US
Mailing Address - Phone:845-708-5021
Mailing Address - Fax:
Practice Address - Street 1:20 SQUADRON BLVD
Practice Address - Street 2:# 350
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5200
Practice Address - Country:US
Practice Address - Phone:845-634-4567
Practice Address - Fax:845-634-4564
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400093391Medicare PIN