Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 25MD00361700 | NJ |
NPI | 1104323302 |
---|---|
Provider Name | Katherine Anne Florio Suskevich |
First Address | Manalapan, NJ 07726-3229 |
Second Address | Manalapan, NJ 07726-3229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2018 |
Last Update Date | 09/09/2021 |