Provider Demographics
NPI:1003955881
Name:ACKERMAN, SUSAN DEE (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DEE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WOODMERE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1017
Mailing Address - Country:US
Mailing Address - Phone:732-297-2723
Mailing Address - Fax:732-940-2691
Practice Address - Street 1:552 BLVD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1655
Practice Address - Country:US
Practice Address - Phone:908-276-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00442800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
521689Medicare ID - Type Unspecified