Provider Demographics
NPI:1710922406
Name:SEO, IN SUK (MD)
Entity Type:Individual
Prefix:
First Name:IN
Middle Name:SUK
Last Name:SEO
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 1:22 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1912
Mailing Address - Country:US
Mailing Address - Phone:201-871-9191
Mailing Address - Fax:718-250-6760
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-8894
Practice Address - Fax:718-250-6760
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145037207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01007698Medicaid
NY54F261Medicare ID - Type Unspecified
NY01007698Medicaid