Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 25MB06461600 | NJ |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 25MB06461600 | NJ |
NPI | 1235209982 |
---|---|
Provider Name | Dr. Susan Janeczek |
First Address | Sewell, NJ 08080-9340 |
Second Address | Sewell, NJ 08080-9340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018473 | (05) | NJ |
H32079 | (02) | NJ |