Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MA06441900 | NJ |
NPI | 1053342865 |
---|---|
Provider Name | Dr. Dewi S Sudjono-Santoso |
First Address | Hightstown, NJ 08520 |
Second Address | Hightstown, NJ 08520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0404226610 | AMERHLTH HMO (01) | |
249850 | UNHC (01) | |
2K0986 | HEALTH NET (01) | |
3134649 | CIGNA (01) | |
36701 | AETNA HMO (01) | |
385405 | AMERHLTH PPO (01) | |
4058994 | AETNA PPO (01) | |
82836 | AMERGRP (01) | |
MEP135 | OXFORD (01) |