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General NPI Number Information
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NPI Number | 1639445539
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Entity Type | Individual
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Provider Name | ANTHONY ODUJE ISEDEH JR. MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 20 YORK STREET, CB-2041
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City | NEW HAVEN
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State | CT
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Zip | 06514-3220
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Country | US
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Telephone | 203-688-4748
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Fax | 203-688-4740
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Provider Business Mailing Address
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Address Line | 201 LYONS AVE
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City | NEWARK
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State | NJ
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Zip | 07011
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Country | US
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Telephone | 973-926-7000
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 25MA09458100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 62045
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License Number State | CT
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