Healthcare Provider Details

I. General information

NPI: 1043283690
Provider Name (Legal Business Name): STEVEN SUSSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 FRANKLIN CORNER RD SUITE 214
LAWRENCEVILLE NJ
08648-2526
US

IV. Provider business mailing address

123 FRANKLIN CORNER RD SUITE 214
LAWRENCEVILLE NJ
08648-2526
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-1400
  • Fax: 609-896-3986
Mailing address:
  • Phone: 609-896-1400
  • Fax: 609-771-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA040927
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD025682E
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA04092700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: