Healthcare Provider Details

I. General information

NPI: 1750655114
Provider Name (Legal Business Name): SUSAN BALDASARE PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 HIGHWAY 35
SEA GIRT NJ
08750-1009
US

IV. Provider business mailing address

2175 HIGHWAY 35
SEA GIRT NJ
08750-1009
US

V. Phone/Fax

Practice location:
  • Phone: 732-974-2929
  • Fax: 732-974-2644
Mailing address:
  • Phone: 732-974-2929
  • Fax: 732-974-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02810100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: