Provider Demographics
NPI:1770584427
Name:MAHAJAN, SUCHETA DEEPAK (MD)
Entity type:Individual
Prefix:DR
First Name:SUCHETA
Middle Name:DEEPAK
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SUCHETA
Other - Middle Name:SHIVRAJ
Other - Last Name:PATIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:38 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1123
Mailing Address - Country:US
Mailing Address - Phone:516-627-4577
Mailing Address - Fax:516-627-4577
Practice Address - Street 1:8675 MIDLAND PKWY
Practice Address - Street 2:OFFICE #2
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3058
Practice Address - Country:US
Practice Address - Phone:718-523-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine