Healthcare Provider Details

I. General information

NPI: 1043068315
Provider Name (Legal Business Name): SUZANNE PENNA MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 RED HILL RD
MIDDLETOWN NJ
07748-3052
US

IV. Provider business mailing address

36 LAYTON AVE
PINE BEACH NJ
08741-1424
US

V. Phone/Fax

Practice location:
  • Phone: 646-888-2629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number826631
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: