Provider Demographics
NPI:1487851366
Name:UDOMSAPH, JOSEPH SUJAI (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SUJAI
Last Name:UDOMSAPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BALTIC ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2724
Mailing Address - Country:US
Mailing Address - Phone:732-208-6066
Mailing Address - Fax:732-549-0025
Practice Address - Street 1:7 BALTIC ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2724
Practice Address - Country:US
Practice Address - Phone:732-208-6066
Practice Address - Fax:732-549-0025
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery