Healthcare Provider Details

I. General information

NPI: 1922091255
Provider Name (Legal Business Name): DR SUZANNE OFFEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 WESTFIELD AVE
WESTFIELD NJ
07090-3312
US

IV. Provider business mailing address

524 WESTFIELD AVE
WESTFIELD NJ
07090-3312
US

V. Phone/Fax

Practice location:
  • Phone: 908-789-1177
  • Fax: 908-789-7431
Mailing address:
  • Phone: 908-789-1177
  • Fax: 908-789-7431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27TO00014400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00437900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number270A00437900
License Number StateNJ

VIII. Authorized Official

Name: DR. SUZANNE R OFFEN
Title or Position: PRES
Credential: OD
Phone: 908-789-1177