Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD01549000 | NJ |
Y | 222Z00000X | Podiatrist | 25MD01549000 | NJ |
NPI | 1013944917 |
---|---|
Provider Name | Mr. Robert E Sussman |
First Address | Neptune, NJ 07753-6116 |
Second Address | Neptune, NJ 07753-6116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3382401 | (05) | NJ |