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General NPI Number Information
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NPI Number | 1770690315
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Entity Type | Individual
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Provider Name | PUDCHONG S SRISETHNIL M.D., F.A.C.E.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 561 E 28TH ST
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City | PATERSON
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State | NJ
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Zip | 07504-1825
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Country | US
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Telephone | 973-278-4673
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Fax | 973-278-0450
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Provider Business Mailing Address
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Address Line | 561 E 28TH ST
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City | PATERSON
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State | NJ
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Zip | 07504-1825
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Country | US
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Telephone | 973-278-4673
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Fax | 973-278-0450
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MA30779
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License Number State | NJ
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