1700993177 NPI number — DR. ULRIKE DREES SUJANSKY MD

Table of content: DR. ULRIKE DREES SUJANSKY MD (NPI 1700993177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700993177 NPI number — DR. ULRIKE DREES SUJANSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUJANSKY
Provider First Name:
ULRIKE
Provider Middle Name:
DREES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DREES
Provider Other First Name:
ULRIKE
Provider Other Middle Name:
DORIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700993177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 HIGHLAND TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-851-8279
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S SAN MATEO DR
Provider Second Line Business Practice Location Address:
STE 424
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-696-4440
Provider Business Practice Location Address Fax Number:
650-696-4445
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A054876 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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