Provider Demographics
NPI:1538452958
Name:COLLEGE POINT MEDICAL P.C.
Entity type:Organization
Organization Name:COLLEGE POINT MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SURYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-321-9688
Mailing Address - Street 1:4211 COLLEGE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4230
Mailing Address - Country:US
Mailing Address - Phone:718-321-9688
Mailing Address - Fax:718-321-9668
Practice Address - Street 1:4211 COLLEGE POINT BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4230
Practice Address - Country:US
Practice Address - Phone:718-321-9688
Practice Address - Fax:718-321-9668
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLEGE POINT MEDICAL P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258689207R00000X
NY204213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH11137Medicare UPIN
NY258689Medicare UPIN