Healthcare Provider Details

I. General information

NPI: 1518281245
Provider Name (Legal Business Name): SUSAN HAGEN MORRISON, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEWARK AVE STE 4
BELLEVILLE NJ
07109-4154
US

IV. Provider business mailing address

77 NEWARK AVE STE 4
BELLEVILLE NJ
07109-4154
US

V. Phone/Fax

Practice location:
  • Phone: 973-450-0100
  • Fax: 973-450-8088
Mailing address:
  • Phone: 973-450-0100
  • Fax: 973-450-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA04095600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number25MA04095600
License Number StateNJ

VIII. Authorized Official

Name: DR. SUSAN HAGEN MORRISON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-450-0100