Surasak Puvabanditsin, MD

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

25MA04160100 Issued in NJ

Practice address

1 Robert Wood Johnson PL
Meb 396
New Brunswick, NJ 08901-1928

Phone

(732) 235-5691

Fax

(732) 235-5668

NPI assigned

Jun 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rutgers Health-RWJ Pediatric Critical CareGroup PAC ID 1355390287, 153 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: spuvabanditsin18196@epicdirect.rwjbh.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rutgers Health-RWJ Pediatric Critical Care

  • Family Medicine Physician
  • New Brunswick, NJ
  • NPI 1780766527
  Medicare reassignment Care Compare group NPD
• Rutgers Health-RWJ Pediatric Critical Care

  • Critical Care Medicine (Anesthesiology) Physician
  • New Brunswick, NJ
  • NPI 1376551093
  NPD
• Community Medical Center Inc

  • General Acute Care Hospital
  • Toms River, NJ
  • NPI 1013010917
  NPD (past)
• Liberty Child and Adolescent Health Services

  • Specialist
  • Jersey City, NJ
  • NPI 1003812728
  NPD (past)
• Robert Wood Johnson University Hospital, Inc

  • General Acute Care Hospital
  • New Brunswick, NJ
  • NPI 1346243375
  NPD (past)

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489708800000",
    "number": "1235135880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 CARRIAGE DR",
            "city": "PISCATAWAY",
            "state": "NJ",
            "postal_code": "088545968",
            "telephone_number": "732-980-9308",
            "fax_number": "732-980-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ROBERT WOOD JOHNSON PL",
            "address_2": "MEB 396",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089011928",
            "telephone_number": "732-235-5691",
            "fax_number": "732-235-5668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUVABANDITSIN",
        "first_name": "SURASAK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2017-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NJ",
            "license": "25MA04160100",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA04160100",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3816508",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric Prystupa
• Kusum A Punjabi, M.D., M.B.A.
• Megha Puri
• Sonika Puri, M.D
• Phillip Ryan Purnell, MD, PHD
• Bernadette Maria Pych
• Gabriella Quadrini, DNP
• Luz Charielle Quezada Mejia, APN
• Wanda Y Quezada, ED. D
• R-Health Primary Care Medical Home LLC

• Neonatal-Perinatal Medicine Physician in New Brunswick, NJ
• Providers in New Brunswick, NJ by specialty
• Neonatal-Perinatal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.