Provider Demographics
NPI:1598870271
Name:SARKODIE, ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:SARKODIE
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 1:516 YORKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7814
Mailing Address - Country:US
Mailing Address - Phone:908-964-7441
Mailing Address - Fax:
Practice Address - Street 1:641 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:862-264-1227
Practice Address - Fax:862-264-1166
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070748207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8593302Medicaid
NJH47762Medicare UPIN
NJ050825Medicare ID - Type Unspecified