Puvabanditsin, Surasak

Puvabanditsin, Surasak is an individual health care provider with primary practice located at 1 Robert Wood Johnson Pl Meb 396, New Brunswick NJ 08901-1928. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine is his primary health care specialty. Puvabanditsin, Surasak can be contacted via phone (732) 235-5691.

Contact Information

Primary practice address
1 Robert Wood Johnson Pl Meb 396 New Brunswick NJ 08901-1928
Phone: (732) 235-5691
Fax: (732) 235-5668
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X 25MA04160100 New Jersey
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 25MA04160100 New Jersey

Profile Details

NPI number 1235135880
LBN Legal business name Puvabanditsin, Surasak
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2005
Last updated Mar 17th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235135880 NPPES
New Jersey MEDICAID 3816508

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