Provider Demographics
NPI:1336583061
Name:SETOGUCHI IWATA, SOKO (MD, DRPH)
Entity Type:Individual
Prefix:
First Name:SOKO
Middle Name:
Last Name:SETOGUCHI IWATA
Suffix:
Gender:F
Credentials:MD, DRPH
Other - Prefix:
Other - First Name:SOKO
Other - Middle Name:
Other - Last Name:SETOGUCHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, DRPH
Mailing Address - Street 1:112 PATERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 PATERSON ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10188800207R00000X
NC201081390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine