Provider Demographics
NPI:1538407655
Name:ROBERT R R SUDOL MD LLC
Entity type:Organization
Organization Name:ROBERT R R SUDOL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUDOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-652-6947
Mailing Address - Street 1:408 E JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9706
Mailing Address - Country:US
Mailing Address - Phone:609-652-6947
Mailing Address - Fax:609-748-9075
Practice Address - Street 1:408 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9706
Practice Address - Country:US
Practice Address - Phone:609-652-6947
Practice Address - Fax:609-748-9075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT R SUDOL MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty