Provider Demographics
NPI:1548262546
Name:NORTHEAST SURGICAL GROUP, PLLC
Entity type:Organization
Organization Name:NORTHEAST SURGICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJDEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-493-7378
Mailing Address - Street 1:551 MUNGER PAVILION
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-493-7378
Mailing Address - Fax:914-594-4949
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE. 0100
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-493-7378
Practice Address - Fax:914-594-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW85991Medicare PIN
NYW85993Medicare PIN
NYW85992Medicare PIN