Active NPI
Daxa Surti, M.D.
- Pediatrics Physician
- West New York, NJ
National Provider Identifier
1598719684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA06048402
- Practice address
- 5301 Broadway
West New York, NJ 07093-2622 - Phone
- (201) 866-9320
- NPI assigned
- May 21, 2006
- Last updated
- Mar 13, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MA06048402 | NJ | Primary |
Addresses
Primary practice location
5301 Broadway
West New York, NJ 07093-2622
Mailing address
363 Manhattan St
Staten Island, NY 10307-1808
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA06048402 | NJ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331596800000",
"number": "1598719684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "363 MANHATTAN ST",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103071808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5301 BROADWAY",
"city": "WEST NEW YORK",
"state": "NJ",
"postal_code": "070932622",
"telephone_number": "201-866-9320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURTI",
"first_name": "DAXA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-21",
"last_updated": "2012-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA06048402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West New York, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.