Healthcare Provider Details

I. General information

NPI: 1184377491
Provider Name (Legal Business Name): SUSAN ELIZABETH NEGGIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 404
HACKENSACK NJ
07601-1941
US

IV. Provider business mailing address

12 RUTGERS TER
FAIR LAWN NJ
07410-3302
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-0660
  • Fax:
Mailing address:
  • Phone: 551-795-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00842900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00843900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: