1831137918 NPI number — DORA IANKELEVNA SULDAN MD

Table of content: KRISTY DENISIA MOREL ARIAS (NPI 1982425252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831137918 NPI number — DORA IANKELEVNA SULDAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULDAN
Provider First Name:
DORA
Provider Middle Name:
IANKELEVNA
Provider Name Prefix Text:
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:
LIDAGOSTER
Provider Other First Name:
DORA
Provider Other Middle Name:
IANKELEVNA
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:
1831137918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
870 PALISADE AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
TEANELK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-692-1661
Provider Business Mailing Address Fax Number:
201-692-9219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
870 PALISADE AVE STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEANECK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07666-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
551-258-4575
Provider Business Practice Location Address Fax Number:
551-258-4574
Provider Enumeration Date:
06/02/2006

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: 208000000X , with the licence number:  MA61030 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6288804 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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