Provider Demographics
NPI:1932125994
Name:SUN, SUNG WOOK (MD)
Entity Type:Individual
Prefix:
First Name:SUNG WOOK
Middle Name:
Last Name:SUN
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 1:10 BERKERY PLACE
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:NJ
Mailing Address - Zip Code:07620
Mailing Address - Country:US
Mailing Address - Phone:201-944-3115
Mailing Address - Fax:201-266-0900
Practice Address - Street 1:10 BERKERY PLACE
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:NJ
Practice Address - Zip Code:07620
Practice Address - Country:US
Practice Address - Phone:201-944-3115
Practice Address - Fax:201-266-0900
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237320207R00000X
NJ25MA07942200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0092312Medicaid
NJ0092312Medicaid
094076VLYMedicare ID - Type Unspecified