MEDICARE: DORA IANKELEVNA SULDAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MA61030	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831137918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORA IANKELEVNA SULDAN MD

Provider Business Mailing Address
First Line	:	870 PALISADE AVE
Second Line	:	SUITE 201
City	:	TEANELK
State	:	NJ
Zip	:	07666
Country	:	US
Telephone Number	:	201-692-1661
Fax Number	:	201-692-9219

Provider Business Practice Location Address
First Line	:	870 PALISADE AVE STE 204
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-3445
Country	:	US
Telephone Number	:	551-258-4575
Fax Number	:	551-258-4574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	01/13/2026

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