Healthcare Provider Details

I. General information

NPI: 1891215174
Provider Name (Legal Business Name): SUUT GOKTURK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERGEN ST
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

37 TARA LN
MONTVILLE NJ
07045-9699
US

V. Phone/Fax

Practice location:
  • Phone: 203-518-3183
  • Fax:
Mailing address:
  • Phone: 203-518-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA11805100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: