Provider Demographics
NPI:1316932213
Name:PAIK, SUNG WOO (MD)
Entity type:Individual
Prefix:
First Name:SUNG
Middle Name:WOO
Last Name:PAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 HIGHWAY 35
Mailing Address - Street 2:STE B-216
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1010
Mailing Address - Country:US
Mailing Address - Phone:732-974-0707
Mailing Address - Fax:732-974-0569
Practice Address - Street 1:2130 HIGHWAY 35
Practice Address - Street 2:STE B-216
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1010
Practice Address - Country:US
Practice Address - Phone:732-974-0707
Practice Address - Fax:732-974-0569
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04048300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA474811Medicare ID - Type Unspecified
E70441Medicare UPIN