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General NPI Number Information
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NPI Number | 1154424182
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Entity Type | Individual
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Provider Name | ROBERT RUSSELL SUDOL MD
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 408 E JIMMIE LEEDS RD
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City | GALLOWAY
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State | NJ
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Zip | 08205-9706
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Country | US
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Telephone | 609-652-6947
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Fax | 609-748-9075
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Provider Business Mailing Address
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Address Line | 408 E JIMMIE LEEDS RD
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City | GALLOWAY
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State | NJ
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Zip | 08205-9706
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Country | US
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Telephone | 609-652-6956
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Fax | 609-748-9075
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 48441
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License Number State | NJ
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