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General NPI Number Information
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NPI Number | 1043399769
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Entity Type | Individual
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Provider Name | SUTINI NGADIMAN MD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 45 READE PLACE VASSAR BROTHERS MEDICAL CENTER
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601
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Country | US
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Telephone | 845-483-6447
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Fax |
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Provider Business Mailing Address
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Address Line | 16 PRESTWICK DRIVE
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City | MONROE
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State | NY
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Zip | 10950
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Country | US
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Telephone | 845-483-6447
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | MA7212
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 187573
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 34487
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License Number State | MN
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