Provider Demographics
NPI:1326273509
Name:SOMCHAI KULWATDANAPORN, M.D., P.A.
Entity Type:Organization
Organization Name:SOMCHAI KULWATDANAPORN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOMCHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:KULWATDANAPORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-742-2077
Mailing Address - Street 1:645 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1926
Mailing Address - Country:US
Mailing Address - Phone:973-742-2077
Mailing Address - Fax:973-653-3585
Practice Address - Street 1:645 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1926
Practice Address - Country:US
Practice Address - Phone:973-742-2077
Practice Address - Fax:973-653-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA035607207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ449091OtherMEDICARE
NJC54934Medicare UPIN