Most Relevant Information
Provider Data
| NPI Number: | 1003571621 |
| Provider Name: | SUSANNA IM |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 26NJ01244400 |
Most Important Dates
| Enumeration Date: | 11/08/2021 |
| Last Updated: | 01/06/2022 |
Provider Practice Location
435 HURFFVILLE - CROSS KEYS RD
WASHINGTON TOWNSHIP
NJ
08080
Practice Location Phone/Fax
| Phone: | 8565822500 |
| Fax: |
Provider Mailing Location
92 PEREGRINE DR
VOORHEES
NJ
080431661
Provider Mailing Phone/Fax
| Phone: | 8562462294 |
| Fax: |