Healthcare Provider Details

I. General information

NPI: 1063963437
Provider Name (Legal Business Name): SUSAN BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 GOFFLE RD
RIDGEWOOD NJ
07450-4027
US

IV. Provider business mailing address

505 GOFFLE RD
RIDGEWOOD NJ
07450-4027
US

V. Phone/Fax

Practice location:
  • Phone: 201-612-1006
  • Fax: 201-612-1091
Mailing address:
  • Phone: 201-612-1006
  • Fax: 201-612-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NN05748000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: