Healthcare Provider Details

I. General information

NPI: 1003913815
Provider Name (Legal Business Name): TROY SUKKARIEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 IRON BRIDGE RD STE 5
FREEHOLD NJ
07728-5305
US

IV. Provider business mailing address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

V. Phone/Fax

Practice location:
  • Phone: 732-780-7603
  • Fax: 732-308-3323
Mailing address:
  • Phone: 908-273-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMA080548
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25MA08054800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: