Provider Demographics
NPI:1811067119
Name:GHONG, SUK I (DPM)
Entity type:Individual
Prefix:MR
First Name:SUK
Middle Name:I
Last Name:GHONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:219 BRIDGE ST
Mailing Address - Street 2:BLD E
Mailing Address - City:MEKUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2291
Mailing Address - Country:US
Mailing Address - Phone:732-635-0400
Mailing Address - Fax:732-635-1511
Practice Address - Street 1:219 BRIDGE ST
Practice Address - Street 2:BLD E
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2291
Practice Address - Country:US
Practice Address - Phone:732-635-0400
Practice Address - Fax:732-635-1511
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJNJ MD02545213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7972903Medicaid
NJ028335Medicare ID - Type Unspecified
U75621Medicare UPIN