Basic Information
| Provider Information | |||||||||
| NPI: | 1336583061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SETOGUCHI IWATA | ||||||||
| FirstName: | SOKO | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD, DRPH | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SETOGUCHI | ||||||||
| OtherFirstName: | SOKO | ||||||||
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| OtherCredential: | MD, DRPH | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 112 PATERSON ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011913 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 PATERSON ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357784 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2013 | ||||||||
| LastUpdateDate: | 09/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA10188800 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.