Dewi S Sudjono-Santoso, MEDICAL DOCTOR
Individual provider Active NPI Pediatric Adolescent Medicine Physician · Hightstown, NJ
NPI 1053342865 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1053342865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Adolescent Medicine Physician 2080A0000X
- License
- MA06441900 (NJ)
- Practice address
- 251 Princeton Hightown Rd
Hightstown, NJ 08520 - Phone
- (609) 448-1421
- Fax
- (609) 395-1978
- NPI assigned
- Jul 6, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA06441900 | NJ | MD | Pediatric Adolescent Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Capital Health System, Inc. | Past | Accepting new patients | |
| Robert Wood Johnson University Hospital, Inc | Past | Accepting new patients | |
| Dewi S. Sudjono-Santoso | Adolescent Medicine | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/5bb47b8f-8587-42a0-80df-8d4eecf69db3/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | MA06441900 | NJ | Yes |
Addresses
Primary practice location
251 Princeton Hightown Rd
Hightstown, NJ 08520
Mailing address
251 Princeton Hightown Rd
Hightstown, NJ 08520
Phone (609) 448-1421
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 249850 | Other | UNHC | |
| 2K0986 | Other | HEALTH NET | |
| MEP135 | Other | OXFORD | |
| 82836 | Other | AMERGRP | |
| 0404226610 | Other | AMERHLTH HMO | |
| 3134649 | Other | CIGNA | |
| 385405 | Other | AMERHLTH PPO | |
| 4058994 | Other | AETNA PPO | |
| 36701 | Other | AETNA HMO |
Other providers in Hightstown, NJ
- Springpoint at Meadow Lakes, Inc
- Springpoint at Meadow Lakes, Inc
- Springpoint at Meadow Lakes, Inc.
- Chelly Marja Sterman
- Sandra Lee Stewart-Davis
- Mary E Sullivan
- Diane Synhorst
- Stephanie Tafone
- The Shoe Buckle
- Margaret Ross Vanhorn
All providers in Hightstown, NJ · Pediatric Adolescent Medicine Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.