Healthcare Provider Details

I. General information

NPI: 1285683532
Provider Name (Legal Business Name): ELLIOT JAY SUCHIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 ROUTE 38 SUITE A
HAINESPORT NJ
08036-2702
US

IV. Provider business mailing address

1261 ROUTE 38 SUITE A
HAINESPORT NJ
08036-2702
US

V. Phone/Fax

Practice location:
  • Phone: 856-222-1975
  • Fax: 856-222-0721
Mailing address:
  • Phone: 856-222-1975
  • Fax: 856-222-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMA 72248
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: