Individual
DR. SURASAK PUVABANDITSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 ROBERT WOOD JOHNSON PL, MEB 396, NEW BRUNSWICK, NJ 08901-1928
(732) 235-5691
(732) 235-5668
Mailing address
32 CARRIAGE DR, PISCATAWAY, NJ 08854-5968
(732) 980-9308
(732) 980-0033
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
25MA04160100
NJ
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
25MA04160100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3816508
—
NJ
Enumeration date
06/28/2005
Last updated
03/17/2017
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