Individual
MOHINDER K GURAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
640 HAWKINS AVE, LAKE RONKONKOMA, NY 11779-2324
(631) 737-0100
(631) 417-1117
Mailing address
55 WATER ST, 2ND FLOOR CRED DEPT, NEW YORK, NY 10041-0004
(646) 680-2888
(516) 542-5556
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
161456
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01352854
—
NY
Enumeration date
05/19/2006
Last updated
09/12/2019
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