Healthcare Provider Details

I. General information

NPI: 1215013198
Provider Name (Legal Business Name): SUSAN G GOMINGER RN,MS,APNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JESSUP RD
PAULSBORO NJ
08066-2413
US

IV. Provider business mailing address

600 JESSUP RD
PAULSBORO NJ
08066-2413
US

V. Phone/Fax

Practice location:
  • Phone: 845-845-4061
  • Fax: 845-384-1770
Mailing address:
  • Phone: 845-845-4061
  • Fax: 845-384-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License Number26NN05354100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NN05354100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number26NN05354100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: