Provider Demographics
NPI:1053342865
Name:SUDJONO-SANTOSO, DEWI S (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:DEWI
Middle Name:S
Last Name:SUDJONO-SANTOSO
Suffix:
Gender:F
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:251 PRINCETON HIGHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08520
Mailing Address - Country:US
Mailing Address - Phone:609-448-1421
Mailing Address - Fax:609-395-1978
Practice Address - Street 1:251 PRINCETON HIGHTOWN RD
Practice Address - Street 2:
Practice Address - City:HIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08520
Practice Address - Country:US
Practice Address - Phone:609-448-1421
Practice Address - Fax:609-395-1978
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA064419002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
249850OtherUNHC
2K0986OtherHEALTH NET
MEP135OtherOXFORD
82836OtherAMERGRP
0404226610OtherAMERHLTH HMO
3134649OtherCIGNA
385405OtherAMERHLTH PPO
4058994OtherAETNA PPO
36701OtherAETNA HMO