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General NPI Number Information
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NPI Number | 1386233062
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Entity Type | Individual
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Provider Name | SUZAN B INCI APN, RN
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Gender | Female
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 95 MAIN AVE STE 274
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City | CLIFTON
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State | NJ
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Zip | 07014-1748
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Country | US
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Telephone | 973-557-0030
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Fax |
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Provider Business Mailing Address
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Address Line | 748 NEW YORK AVE
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City | LYNDHURST
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State | NJ
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Zip | 07071-1623
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Country | US
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Telephone | 973-557-0030
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 26NJ01087600
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License Number State | NJ
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