Healthcare Provider Details

I. General information

NPI: 1871742080
Provider Name (Legal Business Name): SUSAN J BLUMENFELD RNCPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HADDONFIELD BERLIN RD SUITE 105
GIBBSBORO NJ
08026-1228
US

IV. Provider business mailing address

250 HADDONFIELD BERLIN RD SUITE 105
GIBBSBORO NJ
08026-1228
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-0005
  • Fax: 856-784-1799
Mailing address:
  • Phone: 856-346-0005
  • Fax: 856-784-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NN08688200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: