1831338102 NPI number — DR. SUSAN MCMAHON GARDNER O.D.

Table of content: DR. SUSAN MCMAHON GARDNER O.D. (NPI 1831338102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831338102 NPI number — DR. SUSAN MCMAHON GARDNER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER
Provider First Name:
SUSAN
Provider Middle Name:
MCMAHON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCMAHON
Provider Other First Name:
SUSAN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
SUSAN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831338102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 ROUTE 10
Provider Second Line Business Mailing Address:
SUITE 202 WEST TEN PLAZA
Provider Business Mailing Address City Name:
LEDGEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-584-2020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 ROUTE 10
Provider Second Line Business Practice Location Address:
SUITE 202 WEST TEN PLAZA
Provider Business Practice Location Address City Name:
LEDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-584-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2009

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: 152W00000X , with the licence number:  27OA00481600 , 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)