Individual
PAUL SUDAKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
335 GEORGE STREET, OPTICAL BOUTIQUE, NEW BRUNSWICK, NJ 08901
(732) 246-6895
Mailing address
335 GEORGE STREET, OPTICAL BOUTIQUE, NEW BRUNSWICK, NJ 08901
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
31TD00317100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0615441
—
NJ
Enumeration date
12/15/2008
Last updated
12/15/2008
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