Individual
MRS. SURANGANEE MARY DE LANEROLLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 NESCONSET HIGHWAY, STONYBROOK MEDICAL PARK BLDG 16A, STONYBROOK, NY 11790
(631) 246-5454
(631) 246-5902
Mailing address
2500 NESCONSET HWY, BLDG 12B, STONY BROOK, NY 11790-2553
(631) 246-5454
(631) 246-5902
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
152287
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00894654
—
NY
01
—
107738500
DEPT OF LABOR
—
01
—
130015641
RR MEDICARE
—
01
—
4318339
AETNA
—
01
—
AH46028
MDNY
—
01
—
CPNN
WC
—
01
—
CS733
OXFORD
—
01
—
M1522879
WC
—
Enumeration date
10/20/2006
Last updated
11/08/2018
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