Healthcare Provider Details

I. General information

NPI: 1922060334
Provider Name (Legal Business Name): SUSAN MARY EGAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E HANOVER AVE
CEDAR KNOLLS NJ
07927-2020
US

IV. Provider business mailing address

94 PLEASANT HILL RD
RANDOLPH NJ
07869-3466
US

V. Phone/Fax

Practice location:
  • Phone: 973-401-2121
  • Fax: 973-625-7116
Mailing address:
  • Phone: 973-927-3597
  • Fax: 973-401-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number26NJ00080900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: