NPIMap

Individual provider Active NPI

Sukdeb Datta, MD

  • Interventional Pain Medicine Physician
  • New York, NY
National Provider Identifier
1801902788
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
259015-1 Issued in NY
Practice address
90 Park Ave
Suite 1700
New York, NY 10016-1301
Phone
(212) 430-0312
Fax
(121) 430-0412
NPI assigned
Aug 22, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD40269 TN
Interventional Pain Medicine Physician 208VP0014X 25MA08823500 NJ
Interventional Pain Medicine Physician 208VP0014X 259015-1 NY Primary

Addresses

Primary practice location

90 Park Ave
Suite 1700
New York, NY 10016-1301

Mailing address

47 Woodland Ave
Apt 301
Summit, NJ 07901-2175
Phone (615) 479-4692

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
40269TNMDPharmacist
MD40269TNMDAnesthesiology Physician
25MA08823500NJMDInterventional Pain Medicine Physician
259015-1NYMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Surgistar Holdings LLC CurrentSince Apr 9, 2018 Accepting new patients
Garden State Neuro Stimulation LLC Interventional Pain Medicine Past Accepting new patients
Laser Spine & Pain Institute LLC Interventional Pain Medicine Past Accepting new patients
Universtiy Anesthesia Assoc., Inc. Anesthesiology Past Accepting new patients

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1801902788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 WOODLAND AVE",
            "address_2": "APT 301",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079012175",
            "telephone_number": "615-479-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 PARK AVE",
            "address_2": "SUITE 1700",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100161301",
            "telephone_number": "212-430-0312",
            "fax_number": "121-430-0412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATTA",
        "first_name": "SUKDEB",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "MD40269",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NJ",
            "license": "25MA08823500",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NY",
            "license": "259015-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.