Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | NJ |
NPI | 1487851366 |
---|---|
Provider Name | Dr. Joseph Sujai Udomsaph |
First Address | Edison, NJ 08820-2724 |
Second Address | Edison, NJ 08820-2724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 08/07/2007 |