Provider Demographics
NPI:1003082660
Name:DWIVEDI, SUKRUT (DO)
Entity Type:Individual
Prefix:DR
First Name:SUKRUT
Middle Name:
Last Name:DWIVEDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:105 RAIDER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1528
Mailing Address - Country:US
Mailing Address - Phone:908-281-0221
Mailing Address - Fax:908-281-0940
Practice Address - Street 1:1912 STATE ROUTE 35
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2715
Practice Address - Country:US
Practice Address - Phone:732-222-4762
Practice Address - Fax:732-222-4764
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08394700207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease