Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 270A00442800 | NJ |
NPI | 1003955881 |
---|---|
Provider Name | Dr. Susan Dee Ackerman |
First Address | North Brunswick, NJ 08902-1017 |
Second Address | Kenilworth, NJ 07033-1655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |