Provider Demographics
NPI:1447371794
Name:ANG, SIUCOK O (MD)
Entity type:Individual
Prefix:DR
First Name:SIUCOK
Middle Name:O
Last Name:ANG
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 1:68 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2844
Mailing Address - Country:US
Mailing Address - Phone:201-439-0206
Mailing Address - Fax:201-439-0206
Practice Address - Street 1:69 FIRST AVE
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869
Practice Address - Country:US
Practice Address - Phone:908-526-2400
Practice Address - Fax:908-927-1129
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07368800207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology