Provider Demographics
NPI:1720021488
Name:SOSSONG, DUANE G (DO)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:G
Last Name:SOSSONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CENTER GROVE RD STE 17
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4453
Mailing Address - Country:US
Mailing Address - Phone:973-366-1789
Mailing Address - Fax:973-366-6201
Practice Address - Street 1:121 CENTER GROVE RD STE 17
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-366-1789
Practice Address - Fax:973-366-6201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04726400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine