Provider Demographics
NPI:1043251382
Name:GRAY, SUSAN K (RNANP-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:GRAY
Suffix:
Gender:F
Credentials:RNANP-C
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN ANP-C
Mailing Address - Street 1:225 MAY STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3266
Mailing Address - Country:US
Mailing Address - Phone:732-738-8855
Mailing Address - Fax:732-738-4141
Practice Address - Street 1:22 BEVERLY COURT
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-3266
Practice Address - Country:US
Practice Address - Phone:732-738-8855
Practice Address - Fax:732-738-4141
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJP00166800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083205A1VMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID #
NJP56570Medicare UPIN