Provider Demographics
NPI:1053514232
Name:YALLA, SURYA MOHANRAO (MD,)
Entity type:Individual
Prefix:DR
First Name:SURYA
Middle Name:MOHANRAO
Last Name:YALLA
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:62 LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1722
Mailing Address - Country:US
Mailing Address - Phone:201-880-6537
Mailing Address - Fax:718-519-3013
Practice Address - Street 1:3424 KOSSUTH AVE
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT,NORTHCENTRAL BRONX HOSPIT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-519-3013
Practice Address - Fax:718-511-9500
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY209937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine