Provider Demographics
NPI:1467404434
Name:SUDA, ANJULI K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJULI
Middle Name:K
Last Name:SUDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 KINNELON RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2347
Mailing Address - Country:US
Mailing Address - Phone:973-838-0001
Mailing Address - Fax:973-838-1775
Practice Address - Street 1:170 KINNELON RD
Practice Address - Street 2:SUITE 28
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2347
Practice Address - Country:US
Practice Address - Phone:973-838-0001
Practice Address - Fax:973-838-1775
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6383602Medicare ID - Type Unspecified
NJF51220Medicare UPIN