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General NPI Number Information
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NPI Number | 1437158094
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Entity Type | Individual
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Provider Name | SUSAN RAE M.D
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Gender | Female
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Dates
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Enumeration Date | 07/17/2005
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 1031 MCBRIDE AVE SUITE 210 D
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-2559
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Country | US
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Telephone | 973-812-9091
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Fax | 973-339-9040
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Provider Business Mailing Address
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Address Line | 40 MICHELLE WAY
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City | PINE BROOK
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State | NJ
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Zip | 07058-9446
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Country | US
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Telephone | 973-812-9091
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Fax | 973-237-9053
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA06609700
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License Number State | NJ
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