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General NPI Number Information
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NPI Number | 1992861116
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Entity Type | Individual
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Provider Name | SUZANNE W BOTROUS M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 185 CENTRAL AVE STE 308
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City | EAST ORANGE
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State | NJ
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Zip | 07018-3318
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Country | US
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Telephone | 973-678-3776
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Fax | 973-678-6065
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Provider Business Mailing Address
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Address Line | 185 CENTRAL AVE STE 308
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City | EAST ORANGE
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State | NJ
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Zip | 07018-3318
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Country | US
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Telephone | 973-678-3776
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Fax | 973-678-6065
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MA061272
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License Number State | NJ
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