Provider Demographics
NPI:1861402786
Name:DIWAN, SUDHIR (MD)
Entity type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:
Last Name:DIWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E 57TH ST
Mailing Address - Street 2:STE 610
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2049
Mailing Address - Country:US
Mailing Address - Phone:212-535-3505
Mailing Address - Fax:212-535-3568
Practice Address - Street 1:115 E 57TH ST
Practice Address - Street 2:STE 610
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2049
Practice Address - Country:US
Practice Address - Phone:212-535-3505
Practice Address - Fax:212-535-3568
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209697207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW23571Medicare ID - Type Unspecified