Provider Demographics
NPI:1760486385
Name:DATTA, UJJWAL KUMAR (DPM)
Entity Type:Individual
Prefix:DR
First Name:UJJWAL
Middle Name:KUMAR
Last Name:DATTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1946
Mailing Address - Country:US
Mailing Address - Phone:732-537-9200
Mailing Address - Fax:732-356-3750
Practice Address - Street 1:4 E HIGH ST
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1946
Practice Address - Country:US
Practice Address - Phone:732-537-9200
Practice Address - Fax:732-356-3750
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00275800213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95126Medicare UPIN
NJ071763Medicare PIN