Healthcare Provider Details

I. General information

NPI: 1235209982
Provider Name (Legal Business Name): SUSAN JANECZEK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 HURFFVILLE CROSSKEYS RD SUITE 202
SEWELL NJ
08080-9340
US

IV. Provider business mailing address

405 HURFFVILLE CROSSKEYS RD SUITE 202
SEWELL NJ
08080-9340
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-1414
  • Fax: 856-256-5772
Mailing address:
  • Phone: 856-589-1414
  • Fax: 856-256-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB06461600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number25MB06461600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: