NPIMap

Organization Active NPI

Dewi S. Sudjono-Santoso

  • Pediatric Adolescent Medicine Physician
  • Cranbury, NJ
National Provider Identifier
1124417639
Registry record updated Jan 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
MA01513300 Issued in NJ
Legal business name
DEWI S. SUDJONO-SANTOSO
Practice address
339 Princeton-Hightstown Rd
Building B
Cranbury, NJ 08512
Phone
(609) 918-1030
Fax
(609) 918-1322
NPI assigned
Jan 21, 2015
Organization subpart
Yes
Parent organization
DEWI S. SUDJONO-SANTOSOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dewi S Sudjono-Santoso, MDNPI 1053342865
Title
Owner
Phone
(609) 918-1030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X MA01513300 NJ Primary

Addresses

Primary practice location

339 Princeton-Hightstown Rd
Building B
Cranbury, NJ 08512

Mailing address

339 Princeton-Hightstown Rd
Building B
Cranbury, NJ 08512
Phone (609) 918-1030

Other identifiers 1

IdentifierTypeStateIssuer
1053342865MedicaidNJ

Other names 1

  • same as above Other name

National Provider Directory

National Provider Directory
Part of
Dewi S Sudjono-Santoso

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421798400000",
    "number": "1124417639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 PRINCETON-HIGHTSTOWN RD",
            "address_2": "BUILDING B",
            "city": "CRANBURY",
            "state": "NJ",
            "postal_code": "08512",
            "telephone_number": "609-918-1030",
            "fax_number": "609-918-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 PRINCETON-HIGHTSTOWN RD",
            "address_2": "BUILDING B",
            "city": "CRANBURY",
            "state": "NJ",
            "postal_code": "08512",
            "telephone_number": "609-918-1030",
            "fax_number": "609-918-1322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEWI S. SUDJONO-SANTOSO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEWI S. SUDJONO-SANTOSO",
        "enumeration_date": "2015-01-21",
        "last_updated": "2015-01-21",
        "status": "A",
        "authorized_official_last_name": "SUDJONO-SANTOSO",
        "authorized_official_first_name": "DEWI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-918-1030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NJ",
            "license": "MA01513300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053342865",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "same as above",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cranbury, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.