Healthcare Provider Details

I. General information

NPI: 1881919850
Provider Name (Legal Business Name): JOSEPH ALBERT CUDJOE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE
SYRACUSE NY
13210-1602
US

IV. Provider business mailing address

736 IRVING AVE
SYRACUSE NY
13210-1602
US

V. Phone/Fax

Practice location:
  • Phone: 718-866-6346
  • Fax:
Mailing address:
  • Phone: 315-470-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number276053
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: