Healthcare Provider Details

I. General information

NPI: 1558079491
Provider Name (Legal Business Name): SUZANNE LAURA ALLEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 N CENTRAL AVE
RAMSEY NJ
07446-1864
US

IV. Provider business mailing address

100 PIERSON MILLER DR APT A11
POMPTON LAKES NJ
07442-1035
US

V. Phone/Fax

Practice location:
  • Phone: 888-926-1223
  • Fax:
Mailing address:
  • Phone: 862-203-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01395000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: