Provider Demographics
NPI:1144302977
Name:DE LANEROLLE, SURANGANEE MARY (MD)
Entity type:Individual
Prefix:MRS
First Name:SURANGANEE
Middle Name:MARY
Last Name:DE LANEROLLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2500 NESCONSET HWY
Mailing Address - Street 2:BLDG 12B
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2553
Mailing Address - Country:US
Mailing Address - Phone:631-246-5454
Mailing Address - Fax:631-246-5902
Practice Address - Street 1:2500 NESCONSET HIGHWAY
Practice Address - Street 2:STONYBROOK MEDICAL PARK BLDG 16A
Practice Address - City:STONYBROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-246-5454
Practice Address - Fax:631-246-5902
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2018-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1522872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
M1522879OtherWC
NY00894654Medicaid
130015641OtherRR MEDICARE
CS733OtherOXFORD
4318339OtherAETNA
AH46028OtherMDNY
CPNNOtherWC
107738500OtherDEPT OF LABOR
NY00894654Medicaid
107738500OtherDEPT OF LABOR