Provider Demographics
NPI:1821004011
Name:SUNG, EDWARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:SUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-0386
Mailing Address - Country:US
Mailing Address - Phone:609-652-6600
Mailing Address - Fax:609-652-1267
Practice Address - Street 1:72 JIM LEEDS RD
Practice Address - Street 2:STOCKTON MEDICAL BUILDING
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-0836
Practice Address - Country:US
Practice Address - Phone:609-652-6600
Practice Address - Fax:609-652-1267
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA029589207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ179896AZUMedicare PIN