1194969683 NPI number — MS. SUSAN GORMAN L.P.C.

Table of content: MS. SUSAN GORMAN L.P.C. (NPI 1194969683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194969683 NPI number — MS. SUSAN GORMAN L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORMAN
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194969683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 WHIPPOORWILL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKAWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07866-4222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-874-8662
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MORRIS AVE
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
DENVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07834-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-874-8662
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  37PC00390700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4138601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com