=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851414072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT E. SUSSMAN, D.P.M.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 02/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 STATE ROUTE 33 STE 3
-----------------------------------------------------
City | NEPTUNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07753-6116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-776-7260
-----------------------------------------------------
Fax | 732-774-8370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 STATE ROUTE 33 STE 3
-----------------------------------------------------
City | NEPTUNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07753-6116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-776-7260
-----------------------------------------------------
Fax | 732-774-8370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR
-----------------------------------------------------
Name | ROBERT E SUSSMAN
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 732-776-7260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 25MD01549000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------