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General NPI Number Information
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NPI Number | 1467724815
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Entity Type | Individual
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Provider Name | SUZANNE BLIESATH D.V.M
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Gender | Female
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 23 BROOK LAWN DR
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City | LONG VALLEY
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State | NJ
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Zip | 07853-6106
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Country | US
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Telephone | 973-527-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 1 OLD WOLFE RD STE 6
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City | BUDD LAKE
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State | NJ
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Zip | 07828-3213
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Country | US
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Telephone | 973-527-7700
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Fax | 973-527-7699
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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 | 174M00000X
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Taxonomy Name | Veterinarian
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License Number | 29VI00447400
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License Number State | NJ
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