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General NPI Number Information
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NPI Number | 1407848575
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Entity Type | Individual
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Provider Name | JOHN IVAN SUTTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 925 CLIFTON AVE SUITE 102
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City | CLIFTON
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State | NJ
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Zip | 07013-2724
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Country | US
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Telephone | 973-778-2083
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Fax | 973-778-1584
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Provider Business Mailing Address
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Address Line | 11 CHITTENDEN RD STE 102
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City | CLIFTON
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State | NJ
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Zip | 07013-4203
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Country | US
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Telephone | 201-456-4251
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Fax | 973-778-1584
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | MA037771
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA03777100
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License Number State | NJ
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