Active NPI
Paul Sudakov
- Optician
- New Brunswick, NJ
National Provider Identifier
1659516904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 31TD00317100
- Practice address
- 335 George Street
Optical Boutique
New Brunswick, NJ 08901 - Phone
- (732) 246-6895
- NPI assigned
- Dec 15, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 31TD00317100 | NJ | Primary |
Addresses
Primary practice location
335 George Street
Optical Boutique
New Brunswick, NJ 08901
Mailing address
335 George Street
Optical Boutique
New Brunswick, NJ 08901
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0615441 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31TD00317100 | NJ | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229299200000",
"number": "1659516904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "335 GEORGE STREET",
"address_2": "OPTICAL BOUTIQUE",
"city": "NEW BRUNSWICK",
"state": "NJ",
"postal_code": "08901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 GEORGE STREET",
"address_2": "OPTICAL BOUTIQUE",
"city": "NEW BRUNSWICK",
"state": "NJ",
"postal_code": "08901",
"telephone_number": "732-246-6895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUDAKOV",
"first_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-15",
"last_updated": "2008-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NJ",
"license": "31TD00317100",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0615441",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Brunswick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.