Healthcare Provider Details

I. General information

NPI: 1558680561
Provider Name (Legal Business Name): EUGENIA C. KUO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 E RIDGEWOOD AVE
RIDGEWOOD NJ
07450-3915
US

IV. Provider business mailing address

1124 E RIDGEWOOD AVE
RIDGEWOOD NJ
07450-3915
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-2255
  • Fax: 201-489-4799
Mailing address:
  • Phone: 201-489-2255
  • Fax: 201-489-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09530200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: