Provider Demographics
NPI:1962454967
Name:SUDA, ABHAY K (MD)
Entity Type:Individual
Prefix:DR
First Name:ABHAY
Middle Name:K
Last Name:SUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:170 KINNELON RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2347
Mailing Address - Country:US
Mailing Address - Phone:973-838-1717
Mailing Address - Fax:973-838-1775
Practice Address - Street 1:170 KINNELON RD
Practice Address - Street 2:SUITE 28
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2347
Practice Address - Country:US
Practice Address - Phone:973-838-1717
Practice Address - Fax:973-838-1775
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA34985207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ380900520Medicaid
NJ041541SFXMedicare ID - Type Unspecified
NJ380900520Medicaid