Provider Demographics
NPI:1629114913
Name:UDASIN, IRIS G (MD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:G
Last Name:UDASIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:170 FRELINGHUYSEN RD
Practice Address - Street 2:ENVIRONMENTAL & OCCUPATIONAL HEALTH SCIENCES INSTITUTE
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-8020
Practice Address - Country:US
Practice Address - Phone:732-445-0123
Practice Address - Fax:732-445-3644
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-07-23
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA0428452083X0100X
NJ25MA042845002083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0874400Medicaid
NJ0874400Medicaid
NJ572532BZJMedicare PIN
NJ264279BZJMedicare PIN