Healthcare Provider Details

I. General information

NPI: 1447581368
Provider Name (Legal Business Name): SUSAN GATTON A.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CORLIES AVE
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

1610 ROUTE 88
BRICK NJ
08724-3018
US

V. Phone/Fax

Practice location:
  • Phone: 732-775-5500
  • Fax:
Mailing address:
  • Phone: 732-268-8470
  • Fax: 732-268-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00272200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: