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General NPI Number Information
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NPI Number | 1225255243
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Entity Type | Individual
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Provider Name | SOMCHAI KULWATDANAPORN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 645 BROADWAY
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City | PATERSON
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State | NJ
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Zip | 07514-1926
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Country | US
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Telephone | 201-962-8536
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Fax | 201-962-8536
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Provider Business Mailing Address
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Address Line | 645 BROADWAY
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City | PATERSON
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State | NJ
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Zip | 07514-1926
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Country | US
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Telephone | 973-742-2077
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Fax | 973-653-3585
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | MA035607
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License Number State | NJ
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