Provider Demographics
NPI:1144429663
Name:SAKORAFAS, LOIS UDO (MD)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:UDO
Last Name:SAKORAFAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:UDO
Other - Last Name:NWAKANMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:125 PATERSON ST STE 4100
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1962
Mailing Address - Country:US
Mailing Address - Phone:732-235-7766
Mailing Address - Fax:732-235-2964
Practice Address - Street 1:125 PATERSON ST STE 4100
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-235-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA103971002086S0102X, 2086S0127X
CT0515802086S0102X, 2086S0127X
PAMD 4381052086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001515808Medicaid