MEDICARE: SUSAN M LAGE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	25MB05630500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689784159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M LAGE DO

Provider Business Mailing Address
First Line	:	501 IRON BRIDGE RD STE 3
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-5305
Country	:	US
Telephone Number	:	732-462-7030
Fax Number	:	732-308-3562

Provider Business Practice Location Address
First Line	:	501 IRON BRIDGE RD STE 3
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-5305
Country	:	US
Telephone Number	:	732-462-7030
Fax Number	:	732-308-3562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/16/2020

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Directions to “ SUSAN M LAGE DO” Practice Location

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