Provider Demographics
NPI:1073688271
Name:JACQUELINE M SUTERA DPM PC
Entity Type:Organization
Organization Name:JACQUELINE M SUTERA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-391-6731
Mailing Address - Street 1:452 OLD HOOK RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1381
Mailing Address - Country:US
Mailing Address - Phone:201-599-1336
Mailing Address - Fax:201-599-1386
Practice Address - Street 1:452 OLD HOOK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1381
Practice Address - Country:US
Practice Address - Phone:201-599-1336
Practice Address - Fax:201-599-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00279500213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085079OtherGROUP MEDICARE PIN
NJU99984Medicare UPIN
NJ085081TEPMedicare PIN