Provider Demographics
NPI:1083885735
Name:SUK GHONG'S PODIATRY P.C
Entity Type:Organization
Organization Name:SUK GHONG'S PODIATRY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUK
Authorized Official - Middle Name:
Authorized Official - Last Name:GHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-635-0400
Mailing Address - Street 1:219 BRIDGE ST BLDG E
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2291
Mailing Address - Country:US
Mailing Address - Phone:732-635-0400
Mailing Address - Fax:732-635-1511
Practice Address - Street 1:219 BRIDGE ST BLDG E
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2291
Practice Address - Country:US
Practice Address - Phone:732-635-0400
Practice Address - Fax:732-635-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD 02545213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5473780001Medicare NSC