Provider Demographics
NPI:1134369531
Name:UDOYEN, UBONG JACKSON (MD)
Entity type:Individual
Prefix:DR
First Name:UBONG
Middle Name:JACKSON
Last Name:UDOYEN
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 1:58 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1683
Mailing Address - Country:US
Mailing Address - Phone:803-269-7381
Mailing Address - Fax:
Practice Address - Street 1:58 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-1683
Practice Address - Country:US
Practice Address - Phone:803-269-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2654632084P0800X
CT505532084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry